Two Hundred and Sixty Milligrams

I began a very cautious experiment this month.  Once a week, I will take 20mg of Fluoxetine (Prozac) instead of the prescribed 40mg.  Yesterday was the second week I did this.  I am observing carefully for the re-emergence of any obsessive symptoms.  If I notice any, the experiment ends.  If not, I may, with appropriate medical advice, continue.  So far, so good.

I tried about a year ago to jump down from 40mg daily to 20mg.  This didn't work.  Symptoms re-emerged.  My brain got up to its old tricks, and my anxiety increased.  So it was back up to 40mg again.

The thing is, if I go to my GP with this information, I'm almost certain what the advice will be.  Medications are usually prescribed in daily doses of fixed multiples - in the case of Fluoxetine, 20, 40, 60 and up to 80mg for severe depression (which I don't suffer from - I take the medication for OCD, for which it also happens to work).  The advice would be either, stick to the prescribed dose (40mg a day) or switch to 20mg a day for x-number of weeks and take it from there.  More "experimental" variations in dosages aren't recommended.

I don't know exactly why this is, and probably there are good medical reasons for doing so.  On the other hand, I wonder if it's simply that the bureaucracy of medical care isn't equipped for it.  The software doesn't allow for the printing of "variable" prescriptions.  Something like that.  So doctors don't recommend it, even though they could, and may even want to, because they can't.  They also can't prescribe, say, 35mg a day, or 27.639mg, because the drug isn't supplied in those quantities (liquid Prozac does exist, but is rarely prescribed).  Of course, this is just speculation.  But I've learned never to under-estimate the reach and power of inflexible bureaucracy.

Aside: I wonder in the future as medical care becomes more personalised, that such things might come to be.  Designer drugs, and all that.  3D-print your own medication, prescribed specifically for your precise physiological needs. 

So, to a very limited extent, I'm taking my mental health care into my own hands.  The key, as I said, is careful observation.  I'll continue to order my monthly prescriptions as prescribed, but every Monday, omit one of the two daily tablets.  This may turn out to have no effect at all (it's far too soon to tell, as Prozac stays in your system for months) in which case I may make further adjustments.  At the very least, I'll have accumulated an emergency "no deal Brexit" Prozac stockpile (whoopee).  Incidentally, if you happen to be stockpiling medication yourself, you probably don't need to bother - assuming the government's advice can be believed, and...well, um...

I'd like to think it's possible to find my absolute minimum dose.  I've experienced few side effects on Prozac that I'm really conscious of, and the relief it's given me has been quite literally life-saving, but I still wonder about what I may have lost from being on it for so long.  It would be nice to claim even a little of that back again.

Related posts

Twenty Milligrams
Brain


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