GigiG: Lexapro and Zyprexa tapering

[GigiG]

Ive been trying to taper off 100mg sertraline since September 2018. Was prescribed 100mg Sertraline in June 2018 for PND. I was previously on 50 mg in March 2016 for 17 months. 
 

second time round, horrific start up side effects, some symptoms abated, some have persisted. Mostly psychiatric, such as vivid dreams, racing thoughts persist.

 

Ive tapered down to approximately 9mg, with varying success. Made a big jump in August and suffered, uncontrollable crying, racing thoughts, suicidal thoughts etc. Have been paralysed by fear to make any further cuts since August 2019.

 

Ive found a pharmacy in the Netherlands that develop tapering strips and I’ve ordered the strips, starting with 2 months of 9 mg ( approximate current dose of sertraline). I’ve done plenty of research and I do believe them to be legitimate. 
 

However I’m very nervous to switch as this is a generic brand and my past history of horrid side effects and withdrawal symptoms. I know this is much more accurate that what I’ve been doing myself. Has anyone on this forum used tapering strips and should I be so concerned about switching from one brand of sertraline to another?

 

 

 

 

Edited January 5, 2023 by manymoretodays
updated title to present tapering

[Gridley]

Welcome to SA, GigiG.

 

Here is one of our threads on tapering strips.  For more, Google SurvivingAntidepressants.org tapering strips

Tapering strips for psychiatric drugs being produced in ...

As you probably know, we recommend tapering by no more than 10% of your current dose every 4 weeks.

 

Why taper by 10% of my dosage?

 

Regarding switching to a different generic, we recommend a gradual crossover.  Symptoms may bump up a bit when switching but generally resolve fairly quickly.  The only trick is to be sure you have enough of the old brand to make the crossover.

 

3/4 old brand, 1/4 new brand for 3 to 7 days

1/2 old, 1/2 new for 3 to 7 days

1/4 old, 3/4 new for 3 to 7 days

all new thereafter

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

Edited February 18, 2020 by Gridley

[GigiG]

Thank you so much, I really appreciate your help. Do you know where I can find a copy of Joseph Glenmullens symptom tracker? Has anyone else you know of used these tapering strips? 

[Gridley]

 

3 hours ago, GigiG said:

Do you know where I can find a copy of Joseph Glenmullens symptom tracker?

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

Sorry, I don't personally know of anyone else who's used the strips. If you Google SurvivingAntidepressants.org tapering strips, you'll likely find some personal experiences.

[Giulietta]

Hello GigiG

 

Welcome to our group of survivors getting off ADs. I'm sorry about your misery.

 

I don't know anyone here who has not experienced horrific WD symptoms - often as a result of cold turkeys and too fast tapers - accidents and medical errors. Many of us have endured this for months before stabilizing. I am another member - so have only my experience to offer.

 

You might look up the Horowitz article if Gridley didn't already link it to you. It was published in the Lancet last March (I believe) about ADs and tapering.

 

Quick note about me: I had one CT of cymbalta/duloxetine mid-2018. Reinstatement and near CT (error) in 12/2018. H*** began in 1/2019 with ups and downs since then. I am grateful for the good days.

 

Welcome and happy tapering. 😉

 

Giulietta

 

 

 

 

[GigiG]

Hi Guilietta 

 

Thank you so much, am very grateful for this forum. I’ve ordered the tapering strips from the Netherlands, hoping to do it as safely and slowly as possible. Wishing you all the best 

[Revo]

Hi GigiG, how are you doing with the tapering strips?  I'm thinking of trying them myself but as I use escitalopram it would mean switching to citalopram

 

Hope you are doing well

 

Ollie

[GigiG]

Lexapro

 

Zoloft 50 Mg March 2016 – July 2017, too fast a taper but not cold turkey. 

Zoloft  100 mg June 2018 – June 2021 –  slow taper over two years, stopped at 1mg. 

June 2018, had a nervous breakdown, severe anxiety unable to sleep. Hospitalized 25 June till 23 July 2021. 

Was taking Diazepam and Ambien, not longer than two weeks at a time from 25 June till 23 July 2021.

9 July 2021 – started 10mg Lexapro, 

21st July 2021 started 20mg Lexapro. 

Side effects – insomnia, restlessness, apathy etc. I still have anxiety especially in the mornings when I wake up.

As my system is still so sensitive, I don’t want to stop the Lexapro completely, but I’m hoping if I titrate down to 10mg, some of the side effects will diminish. I don’t want to be put on another drug. Currently I take a strong anti-histamine for sleep, but this causes dry mouth, dry eyes and dry nasal passages etc. 

In the UK, you can get the branded Lexapro in 1mg/1ml drops. 

My questions are: 

1. I plan to make a reduction of 5-8% of dose until I get to 15 mg, hold for a while, then get to 10mg. On the lower dose will my side effects get better? I than plan to taper using a compounding pharmacy. 
2. Will there be any issues from going from tablet to liquid in terms of side effects, tolerance etc. 
3. Should I take the liquid 20mg for a few days until I start the taper? 
4. Should my side effects get better as I go down to a lower dosage of 10mg? 

 

Edited September 9, 2021 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

When changing from tablet to liquid it is better to do a cross over.  When you do this you do not make a reduction or any other changes at the same time.

 

The suggested method of the cross over is to do:

 

3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4

 

Do each of these combinations for 3 to 7 days or longer if needed.

 

Generally side effects are related to the dose, so the lower your dose gets the less side effects you have or they are not as bad.  Side effects and withdrawal symptoms are different things.  Withdrawal symptoms occur when the drug is reduced.

 

 

[GigiG]

Hi Chessie Cat, 

 

thank you, when doing the reductions. I want to go from 20-19 mg. could I use tablets and liquid right through the taper or is that not a good idea. For eg - 10mg tablet and 9mg liquid. Just thought it might be easier as trying to do 19mg drops the whole way through?

 

Gigi 

[ChessieCat]

Yes, you can use a combination of tablet liquid.

 

If you decide to do this I think it would be a good idea to still do a cross over, staying on 20mg and doing 15 + 5 and then 10 + 10 before making any reduction.

 

You will need to check to see whether the liquid is once a day or twice a day dosing.  Also check to see what the strength of the liquid is.  And make sure that you know how long before you need to discard the liquid after opening.

[GigiG]

Thank you, that makes sense. The Escitalopram liquid here seems easy to dispense. 1 drop = 1mg. So I would do 15mg tablet and 5 drops to =20mg. Hope that works ok for me, because I am not great at cutting up the pills, it gives me a lot of anxiety. 

[ChessieCat]

When we are trying to get our dose all we can do is our best.  I got my tablet compounded and there is no guarantee that the dose is consistent.

 

Because there may be some inconsistency in your dosing when cutting your tablet it would be a good idea to wait at least 1 week (2 would be better) on the new combination of 10mg tablet + 10mg liquid before making a reduction.  It is better to start from a stable foundation.

 

Your signature says that you are on 9mg sertraline.  But you are taking 20mg escitalopram.  Please add the information (dates and doses) about how you stopped the sertraline, and add the dates and doses for escitalopram.  This allows us to see your drug history at a glance.  We do not need extra details, just a summary.  Thank you.

 

Account Settings – Create or Edit a signature

[GigiG]

Thank you, I’ve just updated my signature. I didn’t add that Im on Zyprexa, I made a jump from 5mg to 2.5mg, was ok on that. Since 3rd September 2021 I was trying to reduce the Zyprexa. I’m on 1.25mg. Not feeling so great. Shall I wait it out or updose back to 2.5mg. Very scared of this drug based on the bad stuff I read. 
 

In your opinion, which drug should I taper first? Are you familiar with the tapering strips from the Netherlands? Thanks for all your help. 

[ChessieCat]

Thank you for updating your drug signature.

 

At this time I suggest that you DO NOT make any changes to the Lexapro including the cross over.  If you are not currently stable, now is not the time to make any changes to other drugs.  You need to get the Zyprexa sorted out first.

 

Please add the reduction to 1.25mg Zyprexa to your drug signature.

 

You have made a lot of changes since 21 July 2021.

 

I'm going to ask the other mods for their assistance.

[ChessieCat]

Gigi, please describe what symptoms you have.

 

When did these symptoms start?  If they began after you started Zyprexa, did they get worse after you started the Promethazine?

 

You might be getting drug interaction from the 3 drugs you are taking.

 

And did you increase Lexapro to 20mg and start taking Zyprexa 5mg on the same day?

[ChessieCat]

On 9/9/2021 at 8:49 PM, GigiG said:

Was taking Diazepam and Ambien, not longer than two weeks at a time from 25 June till 23 July 2021.

 

Just highlighting this for the mods.

 

@GigiG Please include ALL drugs in your signature.

[GigiG]

I was put on the lexapro about two weeks before  I was started on the Zyprexa. My main symptoms are still very heightened anxiety in the morning especially, feeling nervous and some racing thoughts. This has gotten worse over the last week since I’ve reduced the Zyprexa. The main reason why I wanted to come off the Zyprexa was because of the hunger and weight gain.

 

I am having a real problem sleeping and I think that 20mg of Lexapro is just too much for me and might be the culprit.

 

Should I updose the Zyprexa back to 2.5mg and stay on that? I really need to lower the dose of Lexapro as it’s very stimulating for me, I’m not comfortable being on the max dose of 20mg. 

Im not sure the promethazine has caused any issues besides a very dry mouth. 

 

 

[GigiG]

I would imagine that Lexapro is causing more issues than the Zyprexa at this stage as it’s such a high dose?

 

I think the Zyprexa offers at least abit of sedative effect, is this a worse drug than Lexapro even at the small dose of 2.5mg vs the 20mg of Lexapro? 
 

[GigiG]

3 hours ago, ChessieCat said:

When we are trying to get our dose all we can do is our best.  I got my tablet compounded and there is no guarantee that the dose is consistent.

 

Because there may be some inconsistency in your dosing when cutting your tablet it would be a good idea to wait at least 1 week (2 would be better) on the new combination of 10mg tablet + 10mg liquid before making a reduction.  It is better to start from a stable foundation.

 

Your signature says that you are on 9mg sertraline.  But you are taking 20mg escitalopram.  Please add the information (dates and doses) about how you stopped the sertraline, and add the dates and doses for escitalopram.  This allows us to see your drug history at a glance.  We do not need extra details, just a summary.  Thank you.

 

Account Settings – Create or Edit a signature

Hi Chessie Cat,

 

can someone please get back to me. I’m not in a good place, I’m experiencing strange tingling sensations all over my body, it’s terrible and heightens my anxiety. Shall I reinstate the dose of Zyprexa for now from the 1.25mg to 2.5mg? 

[GigiG]

Hi, so I’ve just spoken to my Dr. He says I should go back on 2.5mg Zyprexa, and not make any changes to my medication at the moment. Does that sound sensible? 

[Altostrata]

Hello, @GigiG

 

When did you last make a change in Zyprexa? What new symptoms emerged after you did this?

 

Is this the same doctor who disregarded your adverse effects from 20mg Lexapro and added Zyprexa to mask them?

[GigiG]

Hi Altostrata. 
 

I made a reduction from the Zyprexa on 3 September from 2.5mg to 1.875mg and then 1.25mg. I’m on 1.25mg. 
 

No, it’s not the same Dr who put me on Lexapro. But he is my new Dr. My first Dr yanked me on 20mg of Lexapro within 6 days of starting it. 
 

My new Dr says I should reinstate to 2.5mg and not make any changes to my meds for now whilst I’m unstable. What do you suggest? I’m yet to take my Zyprexa today, I take it at night. Shall I go back up to 2.5mg?

 

 

 

[GigiG]

My symptoms are worsening anxiety again especially in the morning and a strange prickly, burning sensation on parts of my skin and scalp etc, which then fuels the anxiety. 
 

My main reason for wanting to come off the Zyprexa was it gave me an insatiable appetite at round 4pm, where if I didn’t eat I would feel sick and shaky. But I guess that’s not the end of the world. 
 

please advise what I should do. I’ll take my Zyprexa in about 2hours just before bed. 

[GigiG]

1 hour ago, Altostrata said:

Hello, @GigiG

 

When did you last make a change in Zyprexa? What new symptoms emerged after you did this?

 

Is this the same doctor who disregarded your adverse effects from 20mg Lexapro and added Zyprexa to mask them?

Hi Altostrata. 
 

I made a reduction from the Zyprexa on 3 September from 2.5mg to 1.875mg and then 1.25mg. I’m on 1.25mg. 
 

No, it’s not the same Dr who put me on Lexapro. But he is my new Dr. My first Dr yanked me on 20mg of Lexapro within 6 days of starting it. 
 

My new Dr says I should reinstate to 2.5mg and not make any changes to my meds for now whilst I’m unstable. What do you suggest? I’m yet to take my Zyprexa today, I take it at night. Shall I go back up to 2.5mg?

[GigiG]

Hi, 

can someone please reply to my message. 

[ChessieCat]

Is your doctor aware of all the drugs you are currently taking?

 

Please use https://reference.medscape.com/drug-interactionchecker for ALL drugs and copy and the results here in your topic.

 

Are you experiencing any of the symptoms described in the results?

 

Personally, if it was me, I would NOT be increasing any drugs at this time.

[Altostrata]

@GigiG, if I were you, I'd stop changing my drugs right now, let your nervous system settle. You've been making changes every couple of weeks for more than a year.

 

What times o'clock do you take your drugs, with their dosages? Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

Quote

26 June to 31st July - 5-10mg Ambien and Diazepam for anxiety and sleep. 

 

Did you take Ambien and diazepam every day?

[GigiG]

4 hours ago, Altostrata said:

@GigiG, if I were you, I'd stop changing my drugs right now, let your nervous system settle. You've been making changes every couple of weeks for more than a year.

 

What times o'clock do you take your drugs, with their dosages? Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

 

Did you take Ambien and diazepam every day?

Hi Altostrata, 

 

I have gone back up to 2.5mg of Zyprexa. Do you think that’s ok? I really need to sleep, and this causes a sedative effect. Or shall I just stick to 1.25mg? How long should I wait to taper? And what should I taper first? No I didn’t take Ambien and Diazepam everyday, I tried to limit their use. 
 

Have you heard of the tapering strips from the Netherlands?

 

 

[GigiG]

My main issues are :

Anxiety, especially in the morning. I had anxiety before I went on Lexapro.

Unable to sleep without taking melatonin, Zyprexa, and Promethezine.

The most bothersome side effect I have is strange feeling on my skin, random burning, itching and tingly feeling. This comes and goes throughout the day. I had it in the beginning then it went away, and now it’s back again. I had a very bad tingling burning feeling which led to my nervous breakdown. This happened after I got very sick from Covid. This happened in June. 

I took 2.5mg of Zyprexa last night. Should I stay on 1.25 instead? Is the additional 1.25mg likely to make a big difference? 
 

Please let me know, I have two young children to look after. How long before I can start a taper? I plan to use the tapering strips from the Netherlands and taper from 20 to 19,18,17,16,15,14,13,12,11,10 holding every 2-3 weeks or so between dosage changes. I’ll than hold at 10mg for a while before I start an even slower taper to 5mg. 
 

I guess I can handle these side effects as long as they don’t get worse, which is my biggest worry. I think the biggest offender is Lexapro, hence why I’m so desperate to lower my dose of the Lexapro.

 

advice please. 
 

 

[ChessieCat]

If you have only taken 1 dose of 2.5mg Zyprexa I think it would be better to go back to taking 1.25mg.  But you will need to stop changing the dose.  Alto wants the daily symptom notes so that she can try and work out how the drugs your are taking are affecting you and what suggestion she might be able to make to help improve the way you feel.  She will need at least 3 days in a row of the notes so you will need to do your best with non drug coping techniques during this time.

 

non-drug-techniques-to-cope

 

tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia

 

Something that you might not know is that if people take too much or too many drugs that sedate them, it can have a paradoxical effect.  That means that instead of helping you to sleep your body and brain fights against the drugs and tries to keep you awake.

 

As Alto stated:

 

5 hours ago, Altostrata said:

I'd stop changing my drugs right now, let your nervous system settle. You've been making changes every couple of weeks for more than a year.

 

[GigiG]

My main issues are :

Anxiety, especially in the morning. I had anxiety before I went on Lexapro.

Unable to sleep without taking melatonin, Zyprexa, and Promethezine.

The most bothersome side effect I have is strange feeling on my skin, random burning, itching and tingly feeling. This comes and goes throughout the day. I had it in the beginning then it went away, and now it’s back again. 
I took 2.5mg of Zyprexa last night. Should I stay on 1.25 instead. 
 

Please let me know, I have two young children to look after. 

[GigiG]

37 minutes ago, ChessieCat said:

If you have only taken 1 dose of 2.5mg Zyprexa I think it would be better to go back to taking 1.25mg.  But you will need to stop changing the dose.  Alto wants the daily symptom notes so that she can try and work out how the drugs your are taking are affecting you and what suggestion she might be able to make to help improve the way you feel.  She will need at least 3 days in a row of the notes so you will need to do your best with non drug coping techniques during this time.

 

non-drug-techniques-to-cope

 

tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia

 

Something that you might not know is that if people take too much or too many drugs that sedate them, it can have a paradoxical effect.  That means that instead of helping you to sleep your body and brain fights against the drugs and tries to keep you awake.

 

As Alto stated:

 

 

Ok, may I ask why you think it’s not a good idea to reinstate to 2.5mg? I can drop the Promethezine rather? It’s just I did feel better when I was on the 2.5mg. I think I make a drop too big - my dr actually told me I could just stop taking it, luckily I didn’t do that! 

[ChessieCat]

9 hours ago, ChessieCat said:

Please use https://reference.medscape.com/drug-interactionchecker for ALL drugs and copy and the results here in your topic.

 

I requested that you do the drug interaction.  Please do this and you might understand why Alto and I are concerned about the drugs you are taking.

[GigiG]

Hi, I’ve just done the drug interaction. Zyprexa seems to be the offender. I’ll continue to take 1.25mg from now on. How long until I can start a taper? And which drug should I taper first? I imagine the drug that I’m on the highest dose of? 

[ChessieCat]

Please copy and paste the drug interactions here in your Introduction topic.  Thank you.

 

As explained before, Alto has requested that you keep daily symptoms notes.  I also explained that you will need to do this for at least 3 days.

 

Alto cannot offer any advice regarding what to do with your drugs until you have provided the notes and she has assessed them.  You need to provide what has been requested.  Thank you.

 

This is why Alto needs them:

 

On 9/28/2016 at 4:49 AM, Altostrata said:

Keep notes on paper about your daily symptom pattern and drug dosing

 

Are your symptoms worse at any particular times of day? A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs.

 

 

This is what is required.  Please post a full 24 hour period in one post.

 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep