Paul22: should I reinstate escitalopram / Lexapro?

[Paul22]

Hi. I was on Lexapro for 20 years, 20 mgs at the end.  I went off pretty much cold turkey about 6 weeks ago - tapered for about two weeks to try other meds.  Didn't know about this site or the implications. Did not really go forward with other meds. Using small doses of Mirtazapine to sleep.   Went on Lexapro 20 years ago for Anxiety. Depression kicked in a year ago and has gotten much worse. Hence, time for a change from the Lexapro.  Was told it "pooped out." Since going off, Anxiety is back.  Also dizzy and nausea.   Symptoms not as bad as I have read about from others, but I don't want to go back to the Anxiety for sure. Very hard to explain some of the withdrawal effects, but not pleasant. Don't know what I should be doing at this point. I would like to try and reinstate.  The Anxiety was well dealt with on the Lexapro.  Can I reinstate parts of the 20 mg tabs with a pill splitter?  Or should I ask for a low dose Rx? Can I reinstate after 6 weeks?  Should I Reinstate? I would reinstate to go back on, not to taper off. I stopped at the worst point of the depression. Completely upside down logic. I wish I just stayed on.  

 

Edited October 5, 2020 by Gridley

[Gridley]

Welcome to SA, Paul22.

 

There's a saying, "You can't step in the same river twice."  Your nervous system isn't the same nervous system before you cold turkeyed 6 weeks ago.  It is very sensitized from the cold turkey and very likely could not tolerate your previous dose or anything close to it.  

 

Reinstatement of a very small dose of the original drug, in your case Lexapro, is the only known way to help alleviate withdrawal syndrome. Anxiety, dizziness and nausea are typical withdrawal symptoms. The only 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.  At 6 weeks, 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.  These drugs are strong, and when reinstating it is better to start with a small amount and increase if symptoms remain unbearable. 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.  Our usual advice is to say that once you've stabilized on the reinstated dosage, which can take several months,  you can begin a 10% per month taper down to zero.   However, you said you want to go back on the drug, not taper off, though if the drug has pooped out it's not clear to me why you want to go back on it.  

 

Please read:

 

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

 

If you do choose to reinstate, I would recommend a dosage of 1mg--no more, for the reasons I set out above.  A pill cutter isn't a good method, as the doses are inaccurate and inconsistent.   This link explains how to get the low doses of Lexapro you'd need for your reinstatement.  The methods are using a compounding pharmacy, using a digital scale to weigh powder made from tablets, making your own liquid or getting a prescription for liquid Lexapro, which is the easiest method, though some people don't do well with the liquid.

 

Tips for tapering off escitalopram (Lexapro)

 

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 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 October 5, 2020 by Gridley

[Paul22]

Hi. Not sure why I wrote 6 weeks. I stopped in the middle of July.  I originally went on Lexapro 20 years ago for Anxiety/Panic.  However, a year or so ago, I developed depression, with crying spells, etc.  Went to an NP. Felt it was poop out. I was on 20 mgs.  It did help with anxiety very much over the years.  I was to taper off to try other meds.  It was really cold turkey. Went from 20 to 10 to 5 to 0 over a few weeks if that.  Had lots of crying spells, etc. Anxiety was OK at that time.  Now, three months out, I have debilitating anxiety. Actually less depression, but the anxiety is through the roof.  I got an Rx of Lexapro for 5 mg. Just split it into quarters.  Can't get my mind focused to use liquid. Tried a scale - but not sensitive enough.  I started Mirtazapine. I cannot sleep. Prescribed 15.  Split to 7.5 but just started 15.  Only 2 or three nights on 7.5 - took 15 last night.  As soon as the sedation wears off, the anxiety is sky high. I don't know where to turn.  Do I have a shot at reinstatement at low doses? I just want to go back to where I was before I went off Lexapro.  Is this possible 3 months out?  I did not want to go back at full doses.  With Poop-out - that would not make sense anyway - I just want to tackle the withdrawal aspects.  Really appreciate some help. Thanks.

[Gridley]

3 hours ago, Paul22 said:

I just want to go back to where I was before I went off Lexapro. 

The problem is your nervous system isn't the same nervous system it was before you cold-turkeyed Lexapro.  It's now very sensitized.  The Mirtazapine further complicates matters.  Starting a new antidepressant doesn't necessarily eliminate withdrawal from the previous drug.  So your brain is very confused now, trying to get accustomed to no Lexapro and to deal with the addition of the new drug.  I know it's hard to focus but read this link (it's short) explaining what's going on in your nervous system.

 

Brain Remodelling 

 

But, yes, you have a shot at reinstatement.  Since you can't focus on the liquid, If you want to reinstate, I suggest you cut with a single-blade razor blade or pill cutter your 5mg Lexapro into quarters, giving you a 1 1/4mg dose, which would be a reasonable reinstatement dose. That would be the simplest approach. Since you have the scale, I'd use it to weigh each quarter and shave as necessary to get get a consistent dose.  The scale is capable of weighing 1 1/4mg accurately enough for your purposes.  You'll need to order some size 00 gelatin capsules to put the new doses in so as to  include the shavings.

 

Please keep in mind that the purpose of reinstatement isn't to eliminate withdrawal symptoms totally (though it does for some) but rather to bring the symptoms down to a tolerable level.  It takes 4 days for the reinstated dose to reach full strength in your blood steam and a few days more to register in the brain.  If you can, keep daily notes on paper to track how the reinstatement is going.

 

 

 

 

 

 

 

 

 

 

[Paul22]

I'm very concerned and worried.  I realized my scale is Gram, not milligram. I can't get a read on the millagrams..  I tried reinstatement for three days.  Used a pill splitter to split the 5 mg in quarters though very uneven.  The side effects were unreal. Very very strong even at that dose. That said, it also took my anxiety away.  Maybe the side effects overpowered the anxiety. I cannot believe that the initial reinstatement could be therapeutic or that the first day of reinstatement could reduce withdrawal symtoms - could they? I did't take the lexapro yesterday. Today, more anxiety. It's hard to explain but I get a constant anxiety rush. It is not there when I take these small doses of Lexapro, but the side effects are intense.  I know I should not start-stop. I just don't know what to do.  I wish I know about all of this when I went cold turkey in July. So I am at month 3. Do I really have a shot at a reinstatement? I have been reading horror stories and I am getting very nervous..  Looking back, I have been experiencing Akathisia - pacing, trying to get out of my head, etc.  And my insomnia kicked in a couple of months ago,  I suppose I should order a new scale - do I wait or take little bits of the pill?  Better to reinstate or not? I'm really not sure what to do. I have been takin Mirtazapine 7.5 at night.  I feel like this is a total mess. I am really unsure what to do.

[brassmonkey]

Most scales don't actually have a milligram setting. It is determined by how the readout is configured. A display that reads 0.00x g is reading in milligrams. If there are three (3) places to the right of the decimal point while in the gram mode, then you are fine.

[Gridley]

3 hours ago, Paul22 said:

The side effects were unreal.

What were the side effects?  

 

Were you better or worse after the reinstatement?

 

If you feel worse after reinstatement, we recommend you stop the reinstatement.  If you feel better, you can continue--but don't skip doses.  It takes around a week to feel the full effect of the reinstatement.

 

Why do you have to order a new scale? Weigh each of the 4 quarters of the split 5mg tablet.  Use a single-blade razor blade to scrape off and add/subtract until all 4 quarters are approximately the same (doesn't have to be exact).

[Paul22]

The side effects are hard to explain. My head feels like there is pressure, complete strange feelings through my entire body. High have experienced the same feelings but much milder when updosing. You know it is there. Plus nausea. But the anxiety is not there. It seems to suppress the anxiety and other withdrawal effects, even the first time reinstating. Again, all hard to explain. Which is better? Well, if the side effects go away, then I would rather be on it. As to the scale, it is an $11 gram scale. 0.00.   Will not read under 5 or 3 milligrams and not accurate. Today is the second day I stopped reinstatement. Tried for three days. The anxiety is overwhelming. Rushes of anxiety. I will try again tomorrow. Even a tiny shaved piece gives me side effects. I'm quite nervous as to path to take. I am so sorry I stopped in July. 

[Gridley]

@Paul22

 

If you're going to reinstate, you need to do it consistently and give it a week to see how you feel.

 

I'm gathering it's hard to tell whether you're better or worse with the reinstatement.  All I can do is repeat what I said earlier: if you're worse, stop the reinstatement.  If you're better continue for at least a week to get the full effect.

 

 

[Paul22]

I'm getting substantial nausea even from this very small dose (1/4 of a 5 mg pill).  Also very fatigued, (although a little calming). Just not sure to continue or not. Can one feel a difference in one week even from such small doses?  The nausea is awful. Actually have a bit of nausea without it, but this makes it much worse. Currently have insomnia, a little nausea and racing head without reinstatement. On low dose of Mirtazapine at night. Feeling at a crossroads. Afraid it will be too late later. Already at three months.

[Gridley]

11 minutes ago, Paul22 said:

I'm getting substantial nausea even from this very small dose (1/4 of a 5 mg pill).  Also very fatigued, (although a little calming). Just not sure to continue or not. Can one feel a difference in one week even from such small doses?  The nausea is awful. Actually have a bit of nausea without it, but this makes it much worse. Currently have insomnia, a little nausea and racing head without reinstatement. On low dose of Mirtazapine at night. Feeling at a crossroads. Afraid it will be too late later. Already at three months.

If you are feeling worse after the reinstatement, I would stop.

[Paul22]

This is just during the first dose. I have not actually reinstated where It is in my blood stream. These are the side effects I am experiencing. I should have been more clear. 

[Paul22]

I tried three days last week. Tried again yesterday. Just chopping the 5 mg into the best quarters I can. Just hate the side effects. But I am afraid this is my last window. Sitting here trying to decide whether to swallow the next dose. This is very difficult.  Nausea is the major side effect I don't like. My anxiety actually calms a little.  Just not sure what to do here. 

[Gridley]

9 minutes ago, Paul22 said:

Just not sure what to do here

You will have to decide.  If you're feeling better after the reinstatement, you could continue.  If you're feeling worse, you should stop.

[Paul22]

Is it possible to survive 20 years, 20 mg lexapro cold turkey without reinstatement?  I'm at 3 months, all is not well.  That said, wasn't doing great before, but there are noticable differences What are the odds?  Any chance without reinstatement? I look at the pill for a long time before deciding. And using a pill splitter - unequal doses.  Not sure how good this is.  Thank you for taking this time and for your service.  

[Gridley]

1 hour ago, Paul22 said:

Is it possible to survive 20 years, 20 mg lexapro cold turkey without reinstatement? 

Yes, I do believe it's possible to survive 20 years, 20mg Lexapro without reinstatement.  It will likely be rough going for a while (can't say how long).  Shep, one of our administrators, came off 30 years of a variety of types of psychiatric drugs (antidepressants, benzo, antipsychotics, others) cold turkey or fast turkey.  She's doing well.  Take a look at her story and success story.

Shep's Journey

 

I've still not given up on reinstatement.  See below.

 

1 hour ago, Paul22 said:

And using a pill splitter - unequal doses.  Not sure how good this is

Lexapro comes in a liquid in the U.S.  Can you get a prescription? This would be the easiest and most accurate way to reinstate.  You could reinstate 1mg exactly and try that out.  If it's not enough, it would be very easy to increase it little by little, 1 mg at a time.  This would give reinstatement a much better shot at working than the pill cutter with uneven doses.

 

The 3-month mark isn't a hard and fast line.  We've had members reinstate successfully much later.