SSRIs causing problems?

Hey docs,

Quick back story : About 5 weeks ago I made an appointment with my local doctors office to be seen about my depression since it was getting worse. I told them what I was going through at the time and was prescribed 20mg Fluoxetine to take 1 once a day everyday for four weeks. The first week upon taking them I experienced some side effects: dry mouth, mental fog, and I felt a little “out of it” but that was really it. After the initial week though, the side effects cleared up and life went on. The meds definitely helped me feel way better than I have in a very long time. My mood was stabilized for once, and I felt more mentally calm. I explained during the follow up appointment that the meds made a difference. To which my provider (who is an ARNP who works with an MD), asked if I still had depressive thoughts, I said every now and then and that they were very brief but nowhere near what they were pre-medication. She refilled my prescription and instructed that I take 1 and half 20mg tablets and follow up in 8 weeks. She said if at anytime I felt too ‘happy’ then I could drop back down to my original dose of 1 tablet.

A couple days after my dosage increase though, the side effects came back with a vengeance. For a week now, the most often occuring symptoms have have been mild nausea, hot flashes with sweating, random sharp aches and pains in my joints including a headache, reduced appetite, low libido, dry mouth came back today as well, and finally that mental fog. The mild nausea, hot flashes, and the random aches, can be kind of intolerable at times. I noticed the nausea goes away after my the pill(s) have completely left my stomach. I do take them with food in the morning.

Essentially my question is: should I go back down to my original dose of 1 tablet, and will this help clear up my symptoms? Or should I tough it out for a few more days hoping they will go away? as I know SSRIs side effects take about a week or so to diminish. I just thought it was really weird that I am again experiencing these side effects if my body was already used to having to have the meds in my system.

Thank you for your time and all that you do!

Hi there,

Unfortunately we cannot provide you with specific recommendations regarding what to do with your medication dosing. You are correct that the overwhelming majority of SSRI side effects do tend to improve over time, and that may prove to be the case for you as well. However, if not, it may be worth speaking with your physician about going back to your prior dose, as it does sound like you had a significant improvement and were doing OK then.