plantsss: Escitalopram taper from 5 mg: should I reinstate?

[plantsss]

Hi, I thought I’d tell my story and ask for some advice…

 

Around 9 years ago, I started a PhD. Seeing how competitive the academic world is, I put a lot of pressure on myself for doing a “perfect job”. At the same time, I was still living in a student house, where I would repeatedly be disturbed by sudden noises when I was almost falling asleep. Result: I started having some pretty serious sleeping difficulties. Eventually I managed to move, but my new house was in a very loud location with lots of braking/starting trucks, and things only got worse. Finally, after a year, I moved again to a quieter place, and my sleeping problems slowly got better, but in the end, they persisted on and off at some level for the years to come and together with the PhD caused me to be chronically stressed. On top of that, in the final year my father developed cancer and the chemo retriggered his bipolar disorder (first very manic, then a psychotic depression which led to hospitalisation (eventually he recovered)), so that I had to support my parents who were both very distressed.

 

Shortly after this, I moved to a new country, where I was almost immediately socially and professionally excluded by my colleagues (several people have told me the level at which this happened was plain bullying, probably they felt threatened), which caused even more stress, particularly because I had no social network outside work yet (asking myself why… repeatedly trying to fix the situation… eventually starting to doubt myself…). When after a year I finally decided it was time to quit my job (and academia, my dream for the past years), I developed bad eye floaters in my central vision following an accident, which were so distracting that I could not do my job properly anymore/caused constant eye strain, headaches and exhaustion. This was the straw that broke the camel’s back, and I got into a more or less permanent fight-or-flight mode/pretty anxious/slept less and less (very worried about the future job-wise with these floaters and trying to solve the problem by thinking/researching about it). I got laser treatment for the worst floater (doctor said I was indeed unlucky, lots of small ones right in front of the macula which cannot be treated), and started seeing a psychologist. She was very good/supportive, and told me I would have to accept the floaters and how they would impact my life because nothing could be done. 

 

I was not ready to accept that just yet, and read on some internet forums that some people stop seeing their floaters when they take SSRI’s, because noticing them is a problem of the anxious brain rather than something physical. I was pretty desperate at that point, and willing to do anything that would “cure” the floaters, so filled out a questionnaire/put up a show for the psychiatrist to appear depressed and be prescribed anti-depressants (they were already pretty convinced I did not have GAD so I figured that would not work). He went along with what I suggested (that it was a filtering problem of the brain), and gave me escitalopram, to start at 2 mg (drops) and move up to 20 mg (July 2018).

 

Already at the lowest concentrations, I felt the effects of the escitalopram in pretty intense ways. People have told me it’s impossible, but within minutes of taking 2 mg, I felt a warmth spread through my body, being super chilled out, but unable to think more than two sentences straight. Over the next few days, this continued, I felt like I was tripping or something… very spaced out, often I would catch myself lost in thought playing with e.g. my hair for minutes at a time. Memories (happy or neutral) from long-gone times would come up and feel in some way more real than the present. A friend has since told me this is what it is like to take MDMA… one day, I also felt super agitated, as if I had drunk way too much coffee. In any case, I decided to push through, and have all this over with asap because I wanted the floaters gone. The side-effects became a bit better over time, but my memory was terrible, I was much less excited than normally by nice things, was very slow at work, and had zero motivation to do stuff (not in a depressed way, more like “whatever”, I did not even feel like drinking beer...) which was only helped a bit by exercising, so I did that almost every day. For the first hour or so after taking the pills in the morning (got to 20 mg after a few weeks), I felt so spaced out that I did not dare to interact with people too closely for fear they would think I was on illegal drugs.

 

I was hoping the escitalopram would help with the floaters, but it did nothing for that. I talked to the psychiatrist, and he said that if after 8 weeks the side-effects had not become better, they likely would not become better at all… so I dropped to 10 mg (now taken in the evening) over a few days (while also travelling through time zones), which caused pretty bad headaches, but not much else, and I felt much less drugged up. Because I still felt rather zombie-like, had headaches, and the stuff did not help for the floaters, I dropped to 5 mg after a month (October 2018), which went with some emotional ups and downs I think (but still stressed by exclusion/floaters so hard to be sure), but was more or less ok. My psychologist suggested to stay at 5 mg for some more time, because I was clearly less stressed than before I took them.

 

In the end, I did that til the next spring (May 2019), and when she suggested to quit because I was feeling ok long enough (still bothered by exclusion/floater symptoms but not so immensely distressed), I started tapering. Both she and the psychiatrist were sceptical about tapering, but I had read some things by then, and was afraid that cold turkey would be bad (especially given my sensitive reaction when going on the SSRI), so in the end I convinced them and got the drops. I think I roughly did the following: 4 mg (June), 3 mg (July), 2.5 mg (August), 2 mg to 1.5 mg (September), 1 mg (October), 0.5 mg (November), 0.25 mg (December), 0 mg (January). Did not write down exact dates, tried half a step in the first week after reduction, and the full step in the next three weeks. 

 

I often felt somewhat bad after a drop, quite agitated/insomniac (got some sleeping pills for that), but then gradually better. My headaches started to decrease, but sometimes I felt dizzy/depersonalised, and I had almost constant diarrhea (eye floaters seemed to be worse, but not sure). Also, I had some weird moods where I got super angry/moderately sad for no apparent reason, which I found very weird because I had never felt anything like that, especially not so “chemical”/completely random/disjoint from actual events. Especially the anger is so not me, my friends and family did not even believe me/had to laugh when I told them some people found me aggressive (which I think I was on some occasions, although people also pushed me in rather bad ways)… usually these moods would pass after some hours and again I tried to push through because I wanted things to be over with.

 

I talked about having these weird emotions to some family, friends, and my psychologist, but because of several stress factors in my life at that point (working 60-70 hours a week because of a deadline, a narcissistic flatmate who terrorized my life and that of others so that we all had to move out within months without being sure of whether we would be able to find a new place after cancelling the old/bad financial and emotional consequences from his spiteful behaviour), they all said it was only logical I felt like that. But it just didn’t feel normal/right to me, the emotions seemed much too strong, and now reading here I think they were neuro-emotions.

 

After moving to a new place mid-November, I did the final tapering, and jumped off on January 1, at which point I felt relatively ok. I would say that starting from summer, the insomnia gradually got worse, but because of everything happening (move, aftermath from old flat, finally being invited by some colleagues and thus participating in some very late-night/binge drinking events (3AM, 4AM, 5AM…) in December, then doing an alcohol and coffee-free January, still wanting to quit my job/switch careers and countries but feeling I am not moving fast enough because I am a single female mid 30s now) I was not sure whether that was due to getting off the escitalopram. 

 

However, looking back, over the past two months I have had several bouts of pretty obsessive thinking/anger about the whole bullying situation + my boss’s reaction to it (he was the only one I could really talk to. But then, when I told him about the situation (also about the SSRI later), looking for support/him to handle the situation, he suggested that since I was prescribed SSRI’s I must have chronic clinical depression/need to stay on meds for life/am weak/should stay away from challenges in the future (really? Over 50% of people in academia meet DSM criteria of anxiety/depression… are all these people weak/intrinsically flawed??). Which led to a lot of self-doubt/feelings of disempowerment (yes, I was anxious, but even my psychologist (who discharged me in September) said I am not and have never been depressed, and actually it was surprising I had not become that given the circumstances. At the very most, what I had was an adjustment disorder)). 

 

I thought a week or two ago that things were getting better, but then I spent much of last week being really angry, and much of this week being really anxious, while still not sleeping well (actually I am mostly sleeping on melatonin, valerian, passion flower, anti-histamine or (low doses of) lorazepam. I tried ashwagandha because it calmed me down before, but it actually seems to make me more alert now. I also take fish oil, magnesium, and vitamin D). At this point it is better again (not the sleeping, that is still bad), but I am afraid that these waves will come back again, and reading here I am wondering if I should reinstate with a low dose (how much??) to prevent this from becoming a chronic thing.

 

Does that make sense or should I just wait it out? I can survive the symptoms (not nearly as bad as some people here it seems, I can do all I need to do and on some other level “watch” myself/feel that this is not really me but my brain doing weird stuff), would just like them to decrease/be reassured that things will get better… I wrote the whole history because I would like an opinion on whether I need these drugs (I don’t think so, but maybe I am in denial?)/ think I may be really sensitive to the drug (could that be genetic? My father once had a depression, and his bipolar disorder was triggered by the anti-depressants he then took… reading more about it I now feel that this could have been prevented).

 

Also, something I did not mention yet is that I have been having acupuncture treatments for the past month (one more trial to get rid of (the symptoms of the) eye floaters, not really working but anyway). She also senses the anger and anxiety I think (strong heart and liver, weak spleen), and actually the anger started more or less around a treatment last week, which makes me wonder if this is just due to emotional blockages getting released/me doing some necessary emotional processing? I am not usually someone who goes for alternative medicine, but I really have the feeling this does something, after another treatment I was just so tired/relaxed…

 

Thanks a lot for your advice, sorry for the long story but I thought these things might be relevant.

[Gridley]

Welcome to SA, plantsss.  

 

Your taper was a good bit faster than what we recommend (more about that later), and as a result you are now suffering from withdrawal symptoms.  It is especially important to taper very slowly at the extremely low doses. The symptoms you describe--insomnia, obsessive thinking, anger, anxiety--are typical withdrawal symptoms.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Whether in your situation you should reinstate is a difficult decision.  The sole purpose of reinstatement is to make withdrawal symptoms tolerable.  If as you indicate you're doing pretty well, you might want to ride it out.  Do you feel that your symptoms are improving?  So you can make an informed decision, here is some information on reinstatement.

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  You're still in the time period where reinstatement predictably works, up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. We usually suggest a much smaller reinstatement dose than your last dose.  Your system has become sensitized and If you take too much it may be too much for your brain and can cause you become more unstable.    Then, once you've stabilized on that reinstated dosage, which can take several months,  you can begin a 10% per month taper down to zero, which is our recommended taper rate. 

 

Why taper by 10% of my dosage?

 

 Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.

 

If you decide to reinstate, I would recommend a dosage of 0.1mg.  Please let us know what you decide to do.  It's a good idea to keep daily notes on paper to track how your reinstatement is going.

 

As to whether you "need" these drugs, that's beyond the scope of what we do here.  We can tell you that the "chemical imbalance theory" that was concocted by the drug companies to sell drugs has been completely debunked and is a bit of an embarrassment to knowledgable psychiatrists.  I'm sorry your boss made such a hurtful and uninformed statement to you.

Again, chemical imbalance is a myth. Stop the lies, please ...

Regarding the acupuncture, be sure the acupuncturist works only on sedating points, not activating. Withdrawal is not a time to forge ahead on big changes in your psyche; it's a time to be kind to yourself and heal from the drug.

 

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

 

 

 

 

[plantsss]

Thank you Gridley, for the quick reply and helpful info.

 

It's particularly good to know that "riding it out" does not increase the chances of this becoming chronic, I was starting to become a bit afraid of that (and also thinking in the heat of the moment that maybe this IS just me)...

 

I was wondering though in what way insomnia (like 4-5 hours/night atm) will interfere with the CNS recovering? Because I sort of have the feeling that that might slow it down and so it might actually be better to prevent that by going back on for a bit? Or at least take some things that help with insomnia for sure (are the sleep aids that I use ok? Anti-histamine works well, have the feeling passion flower too (have tablets with 250 mg valerian, 50 mg passion flower, and 0.2 mg melatonin... when I do a sleep meditation on that, I fall asleep within minutes (valerian by itself not). Do wake up after 4 hours or so though...)? I already do meditation, exercise, etc.

 

I will think a bit more about the reinstatement, maybe talk to a friend and send an email to my psychologist (she seems quite down to earth/was the one suggesting I go off so I hope she is open to this possibility) to see how they feel. After a rather bad night last night, I am leaning towards trying it, but maybe it would be good to wait one more week to see what happens. The anger/anxiety/insomnia have actually been worse these past two weeks than right after I stopped, so not exactly a sign that things are improving yet unfortunately.

 

I will also tell my acupuncturist about all this, hope she can help as well. I will let you know what I decide to do.

[Gridley]

2 hours ago, plantsss said:

 

I was wondering though in what way insomnia (like 4-5 hours/night atm) will interfere with the CNS recovering?

4-5 hours a night really isn't too bad for withdrawal.  I don't know whether it would interfere with CNS recovering.  My best guess would be no. 

 

Regarding reinstatement, please bear in mind there is no guarantee that it would help your insomnia.  

 

Some have had good results from valerian and passion flower..  One member reported that valerian made her anxious.  Some members have reported that passion flower works for a while then stops.  As always, listen to your body. One thing to be careful of is taking too many sedating drugs, which can cause a paradoxical effect as he body fights to regain normalcy against too much sedation.

[plantsss]

@Gridley: thank you for your reply, and sorry for not answering before. I have been going through some ups and downs over these past few months, and frankly I am not feeling too great atm/worrying more and more about whether things will ever improve.

 

After your previous post, I finally contacted my psychologist for advice on reinstatement, but she did not reply (probably because her email address was no longer working), and I did not follow through after that because of corona (I left the country in a hurry because of closing borders/to be with my family where there were some urgent/severe health issues). In the end I stayed with my family for over six weeks, and during this time I was initially rather agitated (felt locked up/unsure what to do because I could no longer do my normal job, but was also unable to find a different one), and could hardly sleep. Some Passion flower (300 mg + 50 mg valerian + 25 mg lemon balm) seemed to help for that, but after a few days I got very tired/lethargic and scarily enough for the first time something I actually felt was depression, so I decreased and then stopped. I upped my omega 3 (1000 mg) and magnesium citrate (400 mg) and weirdly enough I started sleeping ok. However, I was very emotional about not being home, crying as if I was lovesick, and felt generally still rather restless/ill at ease, constantly pushing myself with a strict schedule to distract myself from my emotions.

 

About a month ago, I went back home, and initially things seemed okish, although I had the feeling that I was suppressing my emotions/I would be able to start crying if only a small thing would happen to trigger it (actually, I was/am quite scared this would happen, or people will see how close the crying is to the surface by just looking at my face). However, I didn't because I have a housemate, and I was afraid he would hear me, and I tried to push myself to just keep going with a strict schedule. At the same time, I also had high hopes for a position I was interviewing for back home, and when that didn't work out two-and-a-half weeks ago, I felt really demotivated/unable to concentrate, etc. as if finally I could no longer keep up the constant pushing through. Also, I felt really alone (atm I don't have a social network + also hardly interaction through work anymore because of home office...), and had to think a lot about all the bullying that happened over the past years which hurt a lot.

 

When my housemate left last week, I finally did some crying, which I think is maybe good, but maybe also just neuro-emotion. At the same time I also started sleeping really badly again, two hours before waking again, feeling rather "on"/not very anxious but more agitated maybe. And then during the day it was more like the opposite, very hard to muster the motivation/concentration to do stuff, not hungry, able to cry... I also took the anti-histamine for sleep again (doxylamine), but after reading online that it affects the CNS I think I should stop (I started reading anatomy of an epidemic).

 

On one level I have the feeling that the lexapro is now finally no longer masking my pain/emotions and I am doing some processing which is good (this is also how my family feels about it, they don't believe the withdrawal part, at least not that it can take so long). But then on the other hand it also all feels just so crappy and chemical, and I am afraid this will only very slowly/never improve, while I need to be active/enthusiastic atm to apply for jobs/switch careers and get out of the crappy professional/social situation that I am in... and when I have a new job I will have to be that too in order not to lose it. Another part of me is also still afraid that I have some sort of chronic mental health condition (depression?) that I just never knew of before, and my boss is right after all...

 

Anyway, all this brings me to my question: I am finally meeting with my psychologist on Monday. And given how much I am struggling atm, I am thinking that maybe I should reinstate after all (0.1 mg is what you suggested?). But then it's been six months already... also, the past months have been pretty ***** up, and I don't want to "undo" that by going back on again/having to go through all this again.

 

What do you say about this? And is there anything else I could do? Is doxylamine safe? Passion flower? Should I lower omega 3/magnesium citrate? I am awake/struggling again right now, and would just like this **** to stop asap...

[plantsss]

Hi @Gridley, do you have any thoughts on this? I had another bad night, and was also thinking about temporarily trying a low dose of 5-HTP (50 mg) as a potential lesser "evil" than reinstatement to ease the process a bit? And then gradually going down from there? Or reinstatement with 0.1 mg (but it's been five months...)? Or occasional use of valerian/passion flower/melatonin?

 

I am getting increasingly scared by reading posts from all the people here who are still struggling a year or further on. And I really need to get myself together/do some work/find another job now... all these emotional ups and downs, often within a day, seem to be so not me, but then I am reminded of "bad" times before (like where I had insomnia, was nervous, etc., the one time that I was crying some years ago, and then I think it may be) and I think maybe it is.

[Gridley]

On 6/3/2020 at 10:49 PM, plantsss said:

my psychologist on Monday. And given how much I am struggling atm, I am thinking that maybe I should reinstate after all (0.1 mg is what you suggested?). But then it's been six months already... also, the past months have been pretty ***** up, and I don't want to "undo" that by going back on again/having to go through all this again.

 

What do you say about this? And is there anything else I could do? Is doxylamine safe? Passion flower? Should I lower omega 3/magnesium citrate? I am awake/struggling again right now, and would just like this **** to stop asap...

First of all, the vast majority of doctors and psychologists know nothing about reinstatement. Is this the same psychologist that was skeptical about tapering and told you to cold turkey at 5mg?

 

Reinstating five (or it is 6?  you mention both) months out is risky and could make matters worse.  It sound like you're doing fairly well and 4-5 hours of sleep isn't bad for withdrawal.  But if you decide to reinstate, 0.1mg is the dose I'd suggest.  If you reinstate and feel worse, stopm immediately.  It takes a little more than a week for the reinstatement to reach full strength in your system; you should gradually start feeling better during that time. 

 

Your doses of omega and magnesium are not particularly high.

 

 I would not recommend 5HTP, or any other psychotropic drug, for withdrawal.  Just because it is "natural" doesn't mean it can't have a very strong effect on the brain.  

 

If you can avoid the antihistamine, I would.

 

Have you considered melatonin for sleep?

 

Melatonin for sleep   

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

 

[plantsss]

Thanks @Gridley, in that case I think I will just hope that things improve sometime soon. I finished anatomy of an epidemic by now and that really strengthens my resolution, the stories there make a lot of sense to me + are pretty scary...

 

I took melatonin (higher concentrations, like 3mg) for a while some years back as a doctors prescription because of insomnia, I still have some of these I think so will see if I can cut them up. Was not too sold on them at that time (very sleepy in the evening, but still not able to sleep through/very groggy in the morning), also don't like the idea that it is a natural hormone that you are taking at way too high concentrations (at least when you take 3mg). But then every now and then may be ok I guess... or I will take the passion flower. Thanks again :)