Relationship on the rocks, what can i expect?

[foolish optim]

So its Prozac instead of Paxil, but since i couldn't find a more appropriate forum than this one I figured maybe you could help. So, about a month ago my girlfriend started prozac at 5mg, increasing 5mg each week until reaching 20mg last sunday. Things were fine until a couple days after she started hitting the 15mg dosage when she became increasingly distant from me until it all came to a head on the last day of 15mg and she basically stopped talking to me.

After some prying she admitted that she no longer felt attracted to me and it was one of those "I love you but im not in love with you" type situations, and she was considering breaking up with me but wasn't sure because she didn't want to make a decision while she was obviously inhibited by the meds, etc. Among other things she also said that she was largely emotionless and felt empty inside and was having difficulty focusing. I told her that SSRI's could inhibit feelings of love, etc. and that her other side effects didn't sound good so she should contact her psychiatrist which she did. So she was on 20mg dosage until about wed or thurs when her psychiatrist told her to go back down to 10mg, which is where she felt happy with the least amount of negative effects (and she still had strong feelings for me as well).

So, she has started taking 10mg daily again, which presumably wont cause any withdrawal effects given the long half-life of the drug and the fact that she wasn't on increased dosage for that long, but what can I expect to happen now? It seems like from what I have read online that as the person comes off the high or whatever they usually tend to redevelop feelings for their former love. Is this the case or am i being a foolish optimist? Has this been your experience? Is the drop from 20mg to 10mg enough to allow these feelings to redevelop? Presumably if she was able to feel something for me at 10mg before she will be able to feel it again, right? Also, about how long do you think it will take before I start to see an increased response from her? Currently she is very robotic and distant and aloof (in fact she is barely speaking to me at all still, im trying to give her space and waiting for her to come talk to me for the most part, and when she does speak to me it seems more like its because she feels obligated to rather than because she wants to), and when she says something that seems to have emotional connotations (like, "Im so happy for you") it seems more like she is saying it because her brain is telling her it is an appropriate or expected response rather than because she actually has any feeling about it. I'm thinking it'll be about 2-3 weeks before I notice something appreciable I think, right?

Thanks for the help!

[scotty]

If she's had these changes on 20mg, don't expect them to go away just because she lowered her dose. The effect is the same on the brain, just at a slower pace with the lower dose.

We see this so many time from loved ones, and the bottom line is that these drugs do change people and if the drug is going to be in play that change will continue.

[foolish optim]

I was under the impression that a lowered dosage meant a lower impact overall on her brain chemistry. I.E. the serotonin levels would decrease and dopamine levels would increase again and the brain chemistry would 'balance out' better? Isn't that the whole point of changing medications and adjusting dosages, to create an effect on the patient that is more suitable to what is desired and to decrease the impact of negative side effects?

Otherwise it sounds like she's basically lost to me forever...

[scotty]

Originally Posted by foolish optim

I was under the impression that a lowered dosage meant a lower impact overall on her brain chemistry. I.E. the serotonin levels would decrease and dopamine levels would increase again and the brain chemistry would 'balance out' better? Isn't that the whole point of changing medications and adjusting dosages, to create an effect on the patient that is more suitable to what is desired and to decrease the impact of negative side effects?

Otherwise it sounds like she's basically lost to me forever...

I wish it was that controlled a response. A 10mg dose of prozac, over time, will result in the same effect on the brain(this is especially true with prozacs long half life). These drugs, as you will discover, are not selective at all and their effect on brain chemistry(which is sketchy at best) is only the beginning of the the effects that they have.
To clarify, yes the higher doses will result in more side effects,but the "falling out of love/not caring" isn't a side effect, it's the "effect" of the drug.

Why did she start Prozac?

[foolish optim]

She started prozac because she nearly killed herself (she had been depressed for a long time and then everything that could go wrong did at the same time) and I convinced her that she should get help for her condition... cruel irony.

I'm not sure the information you are providing is accurate however. The falling out of love thing is also known as emotional blunting. According to this: http://ukpmc.ac.uk/articles/PMC29898...MBvVy87iAq.138 a treatment strategy for emotional blunting is to reduce the dosage. And what I know about chemistry (as well as the discussion I had with a friend that works in the pharmaceutical industry) is that for any given dosage their is an associated "steady state" and that a 10mg dosage has a lower steady state than a 20mg dosage. If its a steady state scenario, then it is impossible for a 10mg dosage to eventually result in the same effects as a 20mg dosage.

Besides that, the entire concept that 10mg will result in the same impact as 20mg over time is silly when having dosages reduced to counteract side effects is a commonly employed strategy according to the research I have done. There are stories of people that have been on high dosage SSRI's for years and then on doctors advice drop down to a lower dose and see a definitive change in effect. If the case is really that "10mg will eventually lead to 20mg" then a change in dosage should have no appreciable effect whatsoever in these scenarios, as the effects of 20mg dosage should still hold true when they drop down, especially after being on it for that length of time.

[scotty]

"At the present time, there are no large-scale epidemiological studies of SSRI-induced indifference. Therefore, we have limited data on general prevalence rates and no data on gender/age/racial distributions, differential rates (if any) among the various SSRIs, and/or adjunctive risk factors such as co-administered drugs, medical conditions, and/or psychiatric comorbidity."

While this quoted study has no large scale studies, this site does. Those here are real world use, and have reported the indifference over and over again, regardless of dose.

Besides that, the entire concept that 10mg will result in the same impact as 20mg over time is silly when having dosages reduced to counteract side effects is a commonly employed strategy according to the research I have done.

This is only silly if one has definitive action in the brain by these drugs. That is not the case. It's not known if 5mg will result in maximum brain chemistry alteration or if 20mg will. It's a huge unknown with ssri's. I know that you want to believe that a lower dose will make things better...and it may, but it's not a guarantee.