Jona: need advice about tapering escitalopram, after 7 years of usage

[jona]

Hello everybody, I am Jona, 27 years old. and very glad that I found this forum.

I will tell you my story with escitalopram in short, and in hope you might have some advice or ideas for me.

(btw, I'm not a native english speaker, so sorry for any language mistakes)

 

I started taking escitalopram 7 years ago, when I was 21 years old (had anxiety, depression)

very quickly my dosage went to 20mg, one pill a day, and so it stayed.

 

After 3 years (age 24), I tried to quit, I did cold turkey (as I reckon you call it), it felt surprisingly good for a month, but during the second month, bad symptoms started slowly (anxiety, confusion, etc).

after another month, I couldn't function at all, and returned to my former routine of one pill a day.

 

after 1 more year (age 25), I started to do something strange, and took the pills totally irregularly (one week - no, the other - yes, two days in a raw - yes, then another week - no, then yes, and then no... and so on...)

 

with this messy method, I stayed for 2 years, until this very day. (I guess I don't like to take these pills, but kind of nervous to stop)

 

during my last 2 years, with this messy method, I can say, honestly, that I'm stable enough, I function alright, no severe symptoms, no alarms.

(whenever I feel bad, it sort of like reminds me to take a pill...)

 

so now, I reached the point, that I want to taper this medicine for good, in a conventional way.

I would be very happy and thankful to hear your thoughts and your opinions, about what should I might do,

considering that I already am taking these pills irregularly and somehow it works for me

(I thought it might mean that my final withdrawal won't be so hard.. hopefully)

 

millions of thanks ahead for all of you who will share your thoughts with me !!!

Jona   

[KarenB]

Hello Jona and welcome to s/a,

 

Thank you for sharing your story with us.  You certainly have traveled the long road with escitalopram. 

 

It intrigues me how you've been so on/off with your doses and have still been okay.  Hopefully this does mean you are not too sensitised to them.  (For many people, such irregularity would make them even more sensitive). 

 

I would recommend tapering in a more regular way, so that your brain doesn't have to cope with both reductions and irregularity at the same time.

 

S/A recommends tapering by no more than 10% of your current dose each month, in order to lessen any withdrawal symptoms.  And here are the Tips for tapering escitalopram.  Depending on how you go, you can slow down as needed.  It's a good idea to make symptom notes. 

 

Would you be able to fill out a signature so we can easily see your details whenever you post?  Thank you.  Well, have a read of those links and then you can come back to this thread to ask any questions you might have.  Slow and steady is the key to tapering safely.

 

Best wishes,

Karen

[Fresh]

Shalom Jona , welcome to the site.  So glad you found your way here - you'll get all the information and support you need to get off these meds in a safe way.

 

In order to taper safely , we need to get an idea of what doses and frequency you've been using the escitalopram , say in the last 2 months.   It would be ideal if you could stabilize on a very small dose daily , rather than taking a big dose infrequently.

 

When you provide more information , we can work out a plan.

Please read all the threads highlighted in blue that Karen has provided.

You might also want to read "What is Withdrawal Syndrome" here http://survivingantidepressants.org/index.php?/topic/603-what-is-withdrawal-syndrome/

and

"About Reinstating and Stabilizing. . . " here http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

Best wishes ,  Fresh

 

.

[Songbird]

It can take about 5 days for changes in dose to show up in the availability of the drug, and if you metabolise more slowly than average, perhaps that is why you've been able to skip doses without a big crash.  Obviously, it eventually shows up, as you say that starting to feel bad reminds you to take it. 

 

To taper properly, you should ideally be taking a consistent daily dose, which will make things much easier on your system, especially as you taper your dose lower.  Choosing how much to start on could be tricky, as it depends what you've been taking lately (which is why Fresh has asked for last 2 months doses and frequencies).  You might not need to take the full 20mg dose each day, as the dose skipping could mean the average availability might be a lot lower than that.

 

You are in a good position, having arrived here before beginning your taper, so you can be armed with good information from the start.

[jona]

Hello! Shalom thank you so much for your responses! you people are wonderful again I want to say just how glad I am that I found this forum. really.

 

I read the links you guys gave me (thanks again!). and I also made a signature.

 

oh, and I forgot to mention before, that at the age of 21, when I got these anxiety attacks that led me to take medication, it was my first time to encounter something like this, never had it before. and I do think it was just a period in my life.

I was always a kind of a moody type of person, but even though I never got to prove it - I don't think I necessarily need medications to function normally.

or at least I hope so

   

Well, here are my conclusions and questions:

 

So stage 1, I need to stabilize my doses. so I'll have where to start to taper off from... 

 

I thought about it, unfortunately, I can't really say what were my doses at the last months

(as awful as it may sound, I really got the habit of playing with it, until I lost track)

 

but I decided that I would feel comfortable with taking my 20mg pill every other day. 

more than that would feel as if I'm going backwards, and with less than that, I would feel stressed.

 

as I understand, you recommend to stabilize a lower daily dose, rather than a higher dose taken at long intervals. since it's easier for the nervous system.

Does it mean I could try a routine of 10mg a day? Will it be equivalent in a way to 20mg every other day?

 

 

My other question is for how long should I stick to my new stabilized routine, until I am safe to start tapering ?

 

Of course it's only assumptions, since I need to keep track with how I feel, but let's say, in case everything goes good.

I think, it sounds reasonable to wait 2 to 3 months, and if nothing strange happens during this time, then I'm ok to start tapering.

But again, I'm not so sure, and would like to hear your opinions...

 

 

About the tapering itself, I guess I have plenty of time to plan this stage.

until that time, I'll go through the articles under 'withdrawal syndrome' (some seem very interesting!)

 

so again, thank you all!!! It's really a pleasure not to go through this dilemmas alone, or with only one dubious psychiatrist...   

[Fresh]

You've found a very special place Jona , we're much more accessible and understanding than your regular doctor .

 

You need to take the same amount every day.  I was thinking 2-5mg , let's see what more experienced moderators advise.

If this isn't working out , you can always increase the dose (updose) after a few weeks.

 

Once things even out , it's a good idea to wait 2-3 months. By then , it's likely you won't have days where you feel you need 20mg.

 

This link explains how to get a small dose from a tablet or capsule. http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

Basically , if you dissolve a 10mg tablet in 20mls of water , each ml contains 0.5mg of medicine.  You need a small glass jar and an oral syringe.   

Other threads that make good reading are 

http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/

and

http://survivingantidepressants.org/index.php?/topic/8489-chickens-liquid-taper-video/

 

Use this thread for journalling , asking questions , venting , whatever.

 

Good to have you on board ,  Fresh

 

.

[brassmonkey]

Hi Jona--  welcome to the group, I'm glad you could join us.  The girls have covered things pretty well with a lot of good information.  Alternating and taking doses at random makes it really hard to figure what dose would be good to try and get you stable.  I will assume that you have some reasoning for saying that you would be comfortable taking 20mg every other day, like you're basing it on what you've been taking.  If that is the case then I would suggest you go with 10mg at the same time every day.  It is very important to maintain your dose every day to keep the levels of the drug constant in your blood.  If you let it fluctuate by skipping days, every other day your body starts to go into WD and that creates instability.

 

There are many reasons for stabilizing on the lowest possible dose.  But in general they boil down to "it's easier on the nervous system".  With all the changes you have done over the past year your system will have become sensitized to the drugs and suddenly giving it a large steady dose could destabilize things, and once that happens it is a lot harder to restabilize them. The other big one is that once stable it gives you a lower point to start your taper from so you won't have as far to go.

 

It is going to take a while for things to sort themselves out.  Waiting 2-3 months will be a good starting point.  Once that time is up you can evaluate how you feel and decide if you're ready or not.  This has to be a long slow process to minimize the WD symptoms and keep you as comfortable as possible.  In the meantime, like you said you can read around the site and learn a lot and get your taper planned and such.

 

Best of luck on your new journey.

[Altostrata]

Welcome, Jona.

 

Have you been taking 20mg every few days? Or more often, or less?

 

What makes you decide to take a tablet? Then what happens?

[jona]

 

thank you all so very much...!

I will answer Altostrata's questions first, in hope it will shade more light on the situation

and after that, I have some more practical questions for you guys, as I'm rethinking about how to stabilize my doses.

 

Trying to explain my irregular routine:

In the last months, there were weeks where I took the tablets 2-3 days in a row, and then, for 2-3 days in a row I didn't take any.

More than once it happened that I didn't take a tablet for a whole week. then I start to feel imbalanced (I'll describe it soon),

which pushes me to take for 2-3 days in a row, until the bad feeling subsides, and so it repeats itself basically, in a loop, kind of.

basically, the more imbalanced I feel - the more motivation I get, to take the tablets in a row.

It also happened that I took it each day for a whole week, but not in the last months. (for at least the 3-4 last months, I don't remember doing so)

 

finally, example of my very last week: first two days - no. next day - yes. the day after - no. two days after - yes. today - I'm still considering.

 

OK.

What do I mean by 'bad feeling':

I get a strange feeling, I feel anxious (as if I'm threatened somehow by the environment),

constant comfortableness (can't sit quietly, stressed), lack of self confidence (I become paranoid of people),

very confused (because it takes me a certain time to realize whether I'm just responding reasonably to unfortunate circumstances, or whether there is nothing in reality to justify what I feel)

physically, I feel strange streams (not sure how to name it otherwise), shivers - the same physical feeling that I learned to identify as the one from when I cold turkeyd a few years ago.

 

 

When it comes to a degree that I recognize it isn't normal anymore (happens rather fast, I wouldn't dare to get carried along with these symptoms)

I return to my tablets, and it relaxes me, at first psychologically maybe, but in 2-3 days, the bad symptoms disappear completely.

 

 

Practical questions I have:

 

With all the changes you have done over the past year your system will have become sensitized to the drugs and suddenly giving it a large steady dose could destabilize things, and once that happens it is a lot harder to restabilize them.

 

 

I was thinking 2-5mg [...] If this isn't working out , you can always increase the dose (updose) after a few weeks.

 

 

so could it be a better idea to start with, let's say, a dose of 5mg a day, and then if I feel bad with it, to increase it? (I can feel comfortable with this idea)

Is it simple to increase the dosage? you start - you feel bad - you increase a little - you wait about a month - you increase more if you need, and not if you don't - ?

if this is a good idea overall, then my next question is - what is dose you'd recommend to increase to, in case the first one fails?

and generally, what do you think about starting with 5mg a day at the beginning? 

 

I'd say, if increasing is easy to handle, and a daily basis is more effective than irregular basis, and maybe I already have sensitized to this med  - then surly I should start as low as I can! (within limits of logic...)

 

 

would be delighted to hear what you have to say!

I feel I learn something from each and every comment. thank you friends

[Altostrata]

Jona, those "bad feelings" were withdrawal symptoms. You felt better when you reinstated the drug for a few days, then you got withdrawal symptoms again.

 

Going back and forth like this is not good for your nervous system. You've been lucky to get away with this for so long.

 

This is just a guess: Take 5mg every day, at the same time each day. Do not, ever, skip a dose. Let us know how you're doing.

 

After a month or so, let's talk about tapering. Please read the links KarenB gave you, Tips for tapering escitalopram   explains how to take a small dose of escilatopram.

[LexAnger]

Hi Jona,

 

I did the exact same irregular dosing for the first couple years since I I started lexapro. I dint have real typical WD problems until I started steady tapering down from 10mg to 2.5mg. My guess is you may be just ok to start tapering following the corrct way from your current dose.

[Songbird]

finally, example of my very last week: first two days - no. next day - yes. the day after - no. two days after - yes. today - I'm still considering.

So the recent pattern looks like No No Yes No No Yes.  Or 20mg about every third day, which kind of evens out at roughly 7mg per day.  With the chaotic dosing you've been doing, I don't think there is any way to define a precise starting dose for you.  I'm thinking you should just choose a dose, say 5mg as a minimum, 10mg as a maximum, and then take that exact same dose daily from then on, and see how that goes.  Try not to worry too much, or get bogged down in 'what if' thinking. Try to keep an open mind - it's quite possible you'll be absolutely fine.

 

[jona]

Hello there everybody

 

So for now, after putting more and more thought to it, my current plan is to start with 8mg, every day, at the same time. as I reckon that time is also important, from what you're saying.

 

I will stay with this for 2-3 months, and then taper off, probably according to the 10% method.

 

If symptoms starts while trying to stabilize on 8mg, I assume I'll reinstate to 10mg. (I'd be glad to hear opinions about this)

but yeah, I guess all these 'what if's (which lead me to rethink my first 5mg conclusion) won't take me far. so we get to the bridge, and then we cross it

 

I'll probably be making my own water-based liquid out of the tablets, following the article (with caution).

but I couldn't really find the approximate shelf-life of escitalpram after you dissolve it in water.

I wonder if anyone here might have experience with this, and could advise me.

 

I will prepare doses for 4 to 5 days in advance.

Is it safe in the refrigerator for this amount of time?

 

I will use this thread to update of my (hopefully) improvement.

and again I wish to thank everybody who contributed from his\her knowledge, gave an opinion and advised.

It means the world to me. I could never explain how grateful I am. (although I have a feeling you actually do understand )

this forum is unbelievable. I'll recommend it to more people I come across, whose willing to taper-off antidepressants.

thank you for setting me on the right way! quicker than I ever imagined

[KarenB]

Sounds like a plan Jona.  Be sure to give it at least 4 days to a week before deciding 8mg isn't enough.  It takes time to register fully in your system. 

 

So glad to hear you sounding so confident.

 

Best wishes,

Karen

[LexAnger]

Sounds a good plan Jona!

hope it works out well for you, fingers crossed.

 

Lex

[Fresh]

"I'll probably be making my own water-based liquid out of the tablets, following the article (with caution).

but I couldn't really find the approximate shelf-life of escitalpram after you dissolve it in water.

I wonder if anyone here might have experience with this, and could advise me.

 

"I will prepare doses for 4 to 5 days in advance.

Is it safe in the refrigerator for this amount of time?"

 

From  http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

"Most homemade solutions may keep for at least a few days, refrigerated. Drugs tend to be degraded by heat and light, which is why pharmacy containers are tinted.

To find tips for your particular drug, see Important topics in the Tapering forum and FAQ . (You can also Google your "medication soluble stability" to see how long yours will keep.)"

 

[Songbird]

If symptoms starts while trying to stabilize on 8mg, I assume I'll reinstate to 10mg. (I'd be glad to hear opinions about this)

 

Sounds like a good plan.  If symptoms are quite severe you might want to updose, but if they are mild you might be able to hold at 8mg and eventually stabilise there.  I'd give it about two or three weeks and then evaluate.