purple: I'm hoping it's withdrawal and not relapse; also, maybe I should quit now while I'm ahead?

[purple]

@Gridley, thank you very much I believe these current experiences will greatly benefit me too and just have to remind myself to be patient. I have set a new intention and commitment to dedicate myself to meditation. Looking forward to being a loving space for myself and others again someday

[purple]

I am so happy to say that I am pretty sure I'm back to normal. The best positive signs are that my creative energy is back (I want to make things!) and that I woke up around 4am today, felt well rested, and decided to get out of bed to get some stuff done. Previously, I would've convinced myself that even tho I felt rested, I wanted more sleep anyway and didn't want to face the day, etc, etc. Today was a huge win!

 

I'm still on the lexapro 10mg. Even yesterday, I was thinking about how even though I wasn't 100%, I still wanted to start a slow taper to 9mg and stay at that for as long as I needed. Today, I've considered it again and even though it may be more expensive in the long run too (it seems the liquid formulations are pricier?), I'm starting to be in a clearer headspace where I'm not going allow being cheap to keep me from being healthier sooner if I can help it. On the other hand, because I'm finally getting back to myself and today was just the first clear day of it, perhaps I should stay at 10mg a while longer but hopefully not for months longer. Curious to know people's thoughts on this

[ChessieCat]

  

On 5/27/2011 at 12:16 PM, Altostrata said:

Lexapro comes in 5, 10, and 20mg tablets

 

You can make a liquid using a saline solution.  See below.

 

Generally when changing from one form of drug to another we recommend doing a cross over which is gentler on your system.  Taking each of the following combinations for 3-7 days (or longer if needed):  3/4 old + 1/4 new, 1/2 + 1/2, 1/4 + 3/4, then all new.  This is done without making a reduction.  Because you would be taking the entire 10mg you can cut up a 10mg tablet to do this because you don't have to be as precise.

 

When you make a reduction it would be better to get 5mg tablets so you could take 5mg tablet and use a 5mg tablet to make a liquid with a saline solution.  See quote below.

 

Also:

 

how-to-make-a-liquid-from-tablets-or-capsules

  

On 5/27/2011 at 12:16 PM, Altostrata said:

Do-it-yourself liquid
People report that they can make their own liquid from Lexapro tablets and water.

It is sparingly soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.

 

 Escitalopram oxalate occurs as a fine, white to slightly-yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane. According to RxList,com.

 

Your best bet would be to use a homemade isotonic saline solution (9% salt in water) which is made by dissolving 9 grams of table salt in 100mL of water. This mixture will last for a month or so in the refrigerator if you haven't added the drug to it.  Once the drug is added it will keep for about a week.

See How to make a liquid from tablets or capsules

 

Using a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

[ChessieCat]

34 minutes ago, purple said:

I'm still on the lexapro 10mg. Even yesterday, I was thinking about how even though I wasn't 100%, I still wanted to start a slow taper to 9mg and stay at that for as long as I needed.

 

When changing to liquid it is better to do a cross over.  This will need to be done BEFORE you commence tapering.

[purple]

Thank you, @ChessieCat! It seemed like lexapro wasn't as soluble in water so that's why I was thinking of getting a prescription for liquid. Then again, if I can save money, it'd certainly be nice to!

[purple]

Oops, nevermind, just saw there's a homemade saline solution I can make. Thank you!!

[purple]

I wanted to give an update for anyone who is curious/following. I'm feeling much much better and went back to a job that is still stressful but manageable enough and has given me much financial stability. I think I stabilized on my AD around Nov/Dec/Jan. I'm meeting with my provider today to discuss tapering. She said she's heard of ADWD and understands so I'm hoping it will be a smooth visit and we can start tapering. I'm currently on Lexapro at 10mg. According to the 10% taper schedule, I should go to 9mg for about a month. I called my insurance and luckily liquid formulation is covered and available though a bit pricey but I can finally afford to pay a little more for things now, phew!

[Shep]

11 hours ago, purple said:

I'm currently on Lexapro at 10mg. According to the 10% taper schedule, I should go to 9mg for about a month.

 

Glad you're doing so much better. Because you're now working, especially in a stressful job, you may want to do a micro-taper. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide may be the best path forward. Instead of reducing by 10% or 5% (if you go with a micro-taper), you make smaller weekly reductions instead of a large monthly reduction. For more, see:

 

The Brassmonkey Slide Method of Micro-tapering

 

As stated in the first post in that thread - " A reduction of 1.25% a week will yield a total drop of 5% or a reduction of 0.625% would give a total drop of 2.5%."

 

I would start out slow and see how you do. 

[purple]

Thank you so much, @Shep!! Luckily I got the liquid formulation and my provider trusts me to self-taper even though I'm still going to check in with her once in awhile to be good. I will try one of the slower methods

[Shep]

Sounds like a great plan, purple. Let us know how you do. 

[purple]

Update time!

 

I've been using the Brassmonkey slide and am currently at 8.6mg of liquid escitalopram. I will update my sig soon! Body started having some constipation in the beginning and still am not completely normal though seem to have a bowel movement everyday again which is good and more normal for me. Body is having trouble regulating its temperature--cold and hot, cold and hot, sweating at night sometimes even though it's not warm enough to be sweating... I had this last summer during that really bad withdrawal. Perhaps I am going a little too fast even though this feels excruciatingly slow.

 

Really recently, what is really bugging me is that I've been taking naps nearly every afternoon for at least the past 2 weeks. Wonder if there's a component of having my IUD taken out about 2-3 weeks ago... But also, very very concerned about adrenal fatigue. Was going to order a saliva test (not sure if they're legit but it's something?) but when I went to order, it said it's not allowed to deliver to my area. Weird.

 

I've been taking 1 capsule of fish oil (looks like it's not enough according to the forums here) and 1 capsule of magnesium citrate 250mg. This morning, I decided to skip my magnesium to see if that would change anything though I suspect it won't. I did however take 2 naps today (1 morning, 1 afternoon). I'm blessed to have work/income that my schedule can be so flexible. At the same time, I wish I could do more with my day. I've been reading the supplements page and am going to looking into adding vitamin E as well as increasing my fish oil dose.

 

Any other insights, recommendations, suggestions are much appreciated. I

 

I am eternally grateful to this community.

[purple]

Attached is what I did/calculated.

[purple]

Looking back on previous suggestions, perhaps I should either bump back up or go even slower with my taper. I recall being incredibly fatigued last summer during my most intense withdrawal but I thought that was just due to fighting the anxiety and darkness inside my head.

 

Also, I used a GoodRx coupon the last time I refilled my liquid formulation and it saved me $100!

 

Ok that's it for now

[purple]

The fatigue really sucks but I did have a mini-vacation that involved a lot of driving myself places and I accidentally hiked 10 miles and got sunburnt. So, yes, many factors but also I believe the fatigue has to do with the stupid drug. I just took a 3.5 hour nap today. Going to have to submit some sick hours for my part-time job. This really sucks. I'll keep you guys posted. I've also decided to hold at 8.6mg just to be extra safe.

 

Interestingly, I was eating pretty plant-based this past weekend because my friend who ran the trails is 100% plant-based.

[purple]

I'm happy to report that my living situation may be changing soon. I've been living with my family which I didn't realize was causing both me and them a lot more anxiety and tension than necessary. I love them dearly and have hopefully communicated that to them enough. I have also let them know I am looking into places to move out into and they seem okay with it. They're slowly letting me be more of an adult haha

[Altostrata]

Did escitalopram always make you fatigued?

[Dee12h]

It makes me incredibly fatigued. I know that can be a symptom of WD for some, but personally my energy goes way up when I lower my dose. It took me going off of it to figure out what was causing my fatigue. I thought I had CFS!

[purple]

4 hours ago, Altostrata said:

Did escitalopram always make you fatigued?

No it doesn't actually. This is the worst fatigue I've had in my life. Usually 2 hour naps in the afternoon with a full 8ish hours of sleep each night. I went back in my records and the incredible fatigue seems to coincide with me getting my hormonal IUD removed a little over a month ago. I had at first attributed the fatigue to a little heavier period after the removal but that explanation doesn't make sense anymore.

[purple]

29 minutes ago, Dee12h said:

It makes me incredibly fatigued. I know that can be a symptom of WD for some, but personally my energy goes way up when I lower my dose. It took me going off of it to figure out what was causing my fatigue. I thought I had CFS!

I think I've noticed the energy increase with lowering my dose but it's very very subtle. I got worried my fatigue was from lowering so that's why I held at 8.6mg for awhile. I remember in med school, when I first got depressed, I thought I had CFS. I'm concerned now about adrenal fatigue so I'm looking into testing panels for it.

[Dee12h]

I’ve had adrenal issues off & on ever since puberty. Maybe the drug affects those with adrenal issues more? 🤷🏻‍♀️ I did lots of other tests last yr when trying to figure out my fatigue, thyroid, etc, and all came back fine except D a little low. But I didn’t test cortisol.

[Altostrata]

A cortisol test relates only to organic conditions, such as Cushing's or Addison's.

 

@purple it could be a change in your withdrawal symptoms was coincidental with IUD removal. Or, did the IUD have a hormone in it?

[purple]

6 hours ago, Dee12h said:

I’ve had adrenal issues off & on ever since puberty. Maybe the drug affects those with adrenal issues more? 🤷🏻‍♀️ I did lots of other tests last yr when trying to figure out my fatigue, thyroid, etc, and all came back fine except D a little low. But I didn’t test cortisol.

Do you mind sharing what kind of adrenal issues you had?

[purple]

2 hours ago, Altostrata said:

A cortisol test relates only to organic conditions, such as Cushing's or Addison's.

 

@purple it could be a change in your withdrawal symptoms was coincidental with IUD removal. Or, did the IUD have a hormone in it?

Yeah, that's what I'm worried about--that the cortisol would only be able to suss out things that are more extreme like adrenal insufficiency which I'm almost 100% sure I don't have. I am curious about what my cortisol pattern looks like though. I suspect it's not spiking in the morning as it should.

@Altostrata, yes I do wonder. The IUD did. It was one of those "tiny" 3-year hormonal ones. I didn't even have it in the full 3 years but I figured I kind of didn't want anymore extra stuff circulating around in my body even though in theory, these are only supposed to stay and affect things locally.

Actually reminds me: my cravings and weight have improved since getting the IUD out. I have less cravings now and even when I do have them, it has been much easier to not cave in to them too much. It is a relief! I still want to do better with eating healthier and working out more but this was a nice small win. I'm a bit more sure that this is more related to the IUD.

 

The fatigue though. I just woke up from my nap and I needed an alarm because I have a Zoom meeting soon. Otherwise, I'd probably still be fast asleep.

[Altostrata]

The 24-hour urine test will not show more subtle variations in cortisol. The spit tests and swab tests are not accurate, their results are meaningless.

[purple]

11 minutes ago, Altostrata said:

The 24-hour urine test will not show more subtle variations in cortisol. The spit tests and swab tests are not accurate, their results are meaningless.

Thank you. I've been trying to find the research behind these. Are you able to guide or direct me on where to look to find the articles?

[Altostrata]

Read up on 24-hour urine test, Cushing's, etc. via Google. Many good medical sources, such as Medscape.

[purple]

Another update, I've been feeling super sensitive today. Feelings of rejection and abandonment came up just by mentioning how my grandparents didn't want to look after me while my parents emigrated and tried to get to the US. Instead, I tagged along with my mom. Maybe this is why I feel like a burden... It all started with a simple conversation this morning with my optometrist. The sensitivity has stayed with me throughout the day. I'm still recovering and haven't gotten much work done today. Hopefully can get some work done this evening.

 

Something similar happened a few weeks ago when I was doing inner child work. It seems I didn't say goodbye to my angsty teenage inner child that morning after completing the meditation and I carried her with me throughout the day.

 

I'm already a sensitive person to begin with. I hate that my AD's made me even more sensitive.

[purple]

I got up at around 7:30am, did my usual morning routine and then napped/slept 9:00-11:30am. **** this haha. I want to ask my medical friends for their opinions but I'm also too overwhelmed with the amount of work and outside input I already have in my life. I do feel better today than yesterday, I think? Maybe I shouldn't have decreased to 8.3mg, wonder if that has to do with anything. Also I'm looking up Cushings even though I'm pretty sure I don't have it. It's more that I'm curious about the cortisol salivary vs urinary vs serum tests.

[Altostrata]

It sounds like you're getting some valuable introspection done! Are you journalling? You might find this very helpful as you come across realizations. It can also defuse the emotionality of these memories.

[purple]

I think I've been making too many excuses to not journal. I finally at least made a voice recording of some interesting dreams I had this morning. Time to re-prioritize things in my life again. I do need to start journaling again to get back in touch with my intuition. Luckily, yesterday I was able to color therapy myself through the emotions. But got no work done. Curious how other people support themselves financially during the recovery journey. I'll look around on the forum to see.

[Dee12h]

On 5/11/2021 at 4:37 PM, purple said:

Do you mind sharing what kind of adrenal issues you had?

I have had low energy, anxiety, startle easily, sensitive to noise & other things, low stress tolerance, craving salt, more thirsty, low bp. I have treated it with various things, adrenal glandular (which I wouldn’t recommend when in WD), vit C, but mainly I use stress management & eating frequent meals. Sleeping in till 9 can help too if that’s possible. I don’t think ADs have helped my adrenals at all! 
 

My nutritionist recommends the Dutch urine tests over others to test hormones & neurotransmitters. I haven’t researched it a ton except looking into my results which were super interesting. My cortisol did the normal am spike, but by early afternoon was near 0, which matched my symptoms. 

[purple]

On 5/12/2021 at 3:32 PM, Dee12h said:

I have had low energy, anxiety, startle easily, sensitive to noise & other things, low stress tolerance, craving salt, more thirsty, low bp. I have treated it with various things, adrenal glandular (which I wouldn’t recommend when in WD), vit C, but mainly I use stress management & eating frequent meals. Sleeping in till 9 can help too if that’s possible. I don’t think ADs have helped my adrenals at all! 
 

My nutritionist recommends the Dutch urine tests over others to test hormones & neurotransmitters. I haven’t researched it a ton except looking into my results which were super interesting. My cortisol did the normal am spike, but by early afternoon was near 0, which matched my symptoms. 

Hi @dee12h, thanks so much for sharing! Yeah, I'm too scared to try too much extra things during this whole process. I'm currently having chrysanthemum tea and am even afraid that's going to adversely affect me in some way.

Oh, I've heard of the Dutch tests! Wow, interesting results. I'm trying to do some more research into all this testing stuff when I have the energy to.

[purple]

Fatigue continues to be bad. Yesterday, I tried to resist napping after lunch. I was able to hold out until 3pm and then I had to cave in. It's so interesting that I'm very sure this isn't mood related because I wake up pretty well-rested and excited for the day. Anyway, I realized I should get some basic labs done too just in case it's something as basic as anemia that's making me tired. Will continue to update. I'm supposed to decrease from 8.3mg to 8.1mg tomorrow which I actually feel okay about because there's been no correlation that I can tell between my fatigue and my escitalopram dosing.

[Altostrata]

What time of day do you take escitalopram vs time you get the fatigue?

[purple]

I take it between 8 and 9am usually. I normally get the fatigue around 1pm, though some mornings after the initial wakeup, I'm already tired by 9/10am but usually not so tired that I require a nap.

[AndyPants]

How is your decrease to 8.1 going?