Fluoxetine

Lyra’s daily medication is Fluoxetine (aka Prozac). She has been taking a dose every day since March 19, 2016. Initially, it made her symptoms far worse. I began to see real progress in July.

The first week on Fluoxetine made it clear that I’d need to track side effects. Lyra was lethargic (for her) and refused to go on a walk all but one day. She spent a lot of her time hiding in my closet and seemed more fragile, emotionally. She continued to be lethargic, a bit “down”, and generally nervous (with a few out-of-the-blue exceptions) until I switched her to two half-doses per day (April 7): her energy partly returned, though she also seemed more reactive in general than she was on the single dose — but that may be simply because she was less groggy. On April 15, I switched back again to one 20 mg dose in the morning to see if the lethargy returned and the reactivity subsided. I kept her on a single dose thereafter. She is now on 30 mg daily.

I tracked her responses to Trazodone — her first as-needed drug — on the Experiments in Medication page; I’ve since begun tracking her response to Clonidine. Here, the focus is on her daily drug — Fluoxetine — since we use the other drugs only rarely.

April 12 (day 25): the change (April 7) to 10 mg twice a day (same overall dose) has helped with her lethargy. She is keener to play and spends less time hiding. However, her reactivity seems higher than while on 20 mg once a day; on the whole, she is currently no less reactive than pre-drug.

April 13 (day 26): I took her to Hannah’s school today. We seldom go this route, but I thought it useful insofar as it gives me a comparison with the last time we did it, pre-medication. She was fine until we got close to the busy road (where a crew was cutting the sidewalk – bad timing!). Her reaction was the same as before: scrambling to cross the road, body low to the ground, panting, some drooling. She sat with me quietly at the school entrance – but kept her eyes on the road and refused treats. Once back across the busy road, onto the quieter streets, she calmed within a minute or two. The rest of the way home she did some perfect loose-leash walking and seemed calm. Overall, my sense is that her reaction was no worse, but no better than before; and although I was pleased with her recovery time, I’m not sure it was any quicker than it would have been pre-drug.

April 15 (day 28): Today, I changed back to 20 mg once a day to see if her lethargy returns. (Also, to see if the rise in reactivity since April 7 subsides.) So far, she seems a little calmer than in the past week, but also sleeping more. She did not react at all to the grocery delivery person in our hall (a new man); she saw him, but simply sniffed at the food in the boxes. She refused cat food (major treat) when she heard the squeal of garbage truck brakes – no surprise there. Yet she was calmer than expected when a loud plane went overhead while we were outside in the yard. And most extraordinarily, she was okay with garbage truck brakes squealing in front of the house: fearful at first, then willing to eat (brakes and engine still audible), then easily diverted to a ball game (truck still audible), and smiling.

April 16 (day 29): so far, on her single 20 mg dose, she is less lethargic than she had been during the first three weeks. We had a good training session in the yard just now: alert and playful. She sleeps a bit more than pre-med, but if she can be alert and teachable for parts of the day, then (again, so far) this seems an improvement, since her reactivity is lower than during the 10mg/10mg week. I wonder if she’s finally getting used to the drug in her system…

April 22 (day 35): She seems to have “accepted” the drug (diminished side effects), and for 4 or 5 days (beginning of week 5) it seemed as if the edge was taken off her reactivity. For the past 3 days, however, she has seemed back to her pre-med reactivity levels. I.e., the best days for reactivity (noticeable improvement) have been days 27 through 32.

May 1 (day 44): I want to revise the statement above. My sense, now, is that her reactivity is sightly improved overall.

May 6 (day 1 of 30 mg): It’s been a tough day for Lyra. She’s very withdrawn and nervous, with only a few bursts of activity. I suspect it’s the drug rather than the garbage trucks (it’s Friday), since she’s lost her appetite as well.

May 13 (day 8 of 30 mg): mild appetite loss continues; she often turns away from treats (even a bully stick) but is eating enough of her kibble. It makes CC a bit harder, but is not extreme. Her energy is lower than before the dose increase — she has little interest in going to the park, which I think is more about energy than fear, as her reactivity to sounds, cars, and people has in general improved over the last few weeks – with the exception (since May 6) of garbage trucks, where she has lost any ground of improvement.

May 23 (day 18 of 30 mg): A slight improvement in energy, though still not enough for long walks. Her reactivity to garbage trucks continues to be worse since starting the medication, but she generally seems calmer around people (the lawn care man with head gear excepted!). Her appetite continues to be low — though not enough to raise concerns about weight loss.

June 1 (day 27 of 30 mg): her energy is closer to pre-med levels than I’ve seen so far; she will walk to the park and play ball on an almost daily basis now, on top of ball games in the yard and training. Her appetite is okay; she only declines treats now if her mind is on something else (or anxious), but she was never highly food motivated to begin with. On the whole, she seems calmer than pre-med, if not placid; her reactivity scores have been below 0 for the past 10 days (with the exception of Friday). This past Friday, her response to the garbage truck was a little better. I feel she has adjusted to the 30 mg dose, so I will try her on trazodone one of these days. However reluctant I am to experiment further, I need to know if any situational drug, or add-on, will help. Today I took her to a busier stretch of road, and she was quite anxious, straining at the leash with her tail straight down until we moved away from the noises. While she was quick to recover, we’ve still (clearly) got a long way to go.

June 27 (day 53 of 30 mg): I feel I can now say that her energy level is pretty normal (it’s hard to tell in the heat) and her appetite has been normal for the past few weeks (i.e., her old fussy self).

August 28, 2016: she is on the full dose of fluoxetine (30mg), for her weight, and no longer shows side effects — except perhaps for a slight lowering of energy overall. (It’s hard to compare a nearly-adult dog with her puppy self.) Toward the end of July, I began to see real progress with her counter-conditioning to car travel — she happily jumped into Margaret’s car, even after a car ride — and to triggers in general.

Sept 2, 2016: I feel we’ve recovered some ground, finally, with garbage trucks. Today, Lyra was able to play ball in the yard while a truck was audibly nearby; in the house, she lay in the closet when she heard a truck, but she licked cheese from my finger even while the truck was still on our road (and thus audible). This is huge progress from a few months ago. It gives me courage to begin a more systematic work on CC with trucks — once I come up with a plan that avoids the problems of the last one.

Sept 16, 2016: Lyra stayed upright and responsive in the front room today, licking cheese (Cheez Whiz, to be exact), while a garbage truck was on our street. She stood outside on the front porch and watched with mild curiosity but NO sign of stress when a cement-mixer truck drove past. Yesterday, she licked cheese while watching boys scoot past the house (on very clattery wheels). Here’s how I picture things right now: it’s as if there is a bigger gap in her brain between registering the sound and a full-blown reaction (shutting down in the case of G. trucks, barking and lunging in the case of scooters). The gap allows entry for high-value treats — which gives me hope that one day she’ll have a healthy emotional response to these triggers. At this point (nearly 6 months from the day we started fluoxetine) I feel certain she’s improving — because of this gap, because she’s “cheerful” more often, and because her recovery time is shorter.

Here is the chart I was (until June 28) using to track her overall response to drugs, with the option of numeric data (though I realize it is still pretty subjective):

I have since created a new chart that will track both reactivity and training — which I am now going to keep in the tracking progress section of this site, to reflect that shift away from side effects to effects on behaviour and learning.

See also posts on this blog under the category of Lyra/medication.