Camille: Lexapro WD "threshold"from 5mg to 2.5mg?

[Camille]

Hello, I need some recommendation for my tapering. Here is my background

At 15, i had a massive burn-out and was prescribed antidepressants. I am today 23 and have been on antidepressants almost without interruption. I don't remember all the different antidepressants I was on. I know it did help when i was in emergency situation (extreme anxiety and depression) but it was not satisfactory either, that's why i always had the intention to stop. I quit Effexor once and Brintellix once without a very long taper and didn't feel any major WD symptoms, except that my depression and anxiety (that was already here before) came back, but not worse than it was before. In January 2020, i was prescribed with Lexapro 15mg. After 3 months of use, I decided to taper (in April 2020). Everything was going pretty fine with no any WD symptoms (except a few headaches the first week after a decrease). But in June, when i decreased my dose from 5mg to 2,5 mg, I instantly felt more horrible than I had ever did (so it wasn't a return of my original depression). I wasn't able to do any movements without being out of breath and i felt more anxious and depressed than i had ever been, I could only describe it as "hell"with terrible emotions that i had never felt before, not even close. I waited something like 5 days and I decides to come back to 5mg because it unbearable. Coming back to 5mg wasn't enough to reverse these symptoms so i had to come back on 10mg. 
I want to taper again. I decreased my dose from 10mg to 7,5mg in September without any major symptoms. I've been stable ever since (we are now in December so i want to decrease my dose again to 6mg. The thing is I dont understand why in my last experience, i had no symptoms whatsoever until I decrease from 5mg to 2,5mg and I dont know how to avoid that from happening again. Is there like some sort of a "threshold dose" where everything goes bad if you go below it ? I'm feeling fine right now but i know how fast everything can go real bad.

Thanks in advance for your answer and also thanks for this existence of this website

Edited December 4, 2020 by manymoretodays
moved from S and S care, name added to title

[Gridley]

Welcome to SA, Camille.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Your history in 2020 is the most important.  A list format is best.

 

Account Settings – Create or Edit a signature.

 

Lexapro is the strongest SSRI on the market (2 to 4 times as strong as Celexa or Paxil) and the the lower doses of Lexapro (from 10mg down) are the most potent, which (along with the fact that you reduced by 50%) would explain why you got "caught"  with withdrawal when you got down to the very low, very strong doses.  There is no such thing as a threshold dose where everything goes bad if you go below it.  If you taper slowly enough, you will be able to taper down all the way to zero.  I recently completed tapering off 20mg Lexapro after a 4-year taper, jumping to zero at 0.025mg.  

 

Your drop from 5mg to 2.5mg was a 50% drop, five times faster than what we recommend.  That reduction, at the point where Lexapro is very  potent, caused the withdrawal symptoms you experienced.  We recommend tapering no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Lexapro, including how to get the nonstandard doses needed for a 10% taper.

 

Tips for tapering off escitalopram (Lexapro)

 

It is too soon to taper again.  You've made many changes in your dosage recently, including a very large reinstatement and a 50% decrease, leaving your system in a sensitized state, and I'd recommend you stabilize where you are at 7.5mg for at least three months before tapering again.  Withdrawal symptoms can be delayed, and you would be well-served by a hold at this point.  Decreasing from 10mg to 7.5mg was a 25% decrease, and withdrawal symptoms can be delayed.  Deceasing from 7.5mg to 6mg is a 20% decrease, twice what we recommend.  After your hold I recommend you taper by no more than 10% of your current dose.  

 

So that you have a better idea of withdrawal and the healing process, here are some helpful links:

 

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.  

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

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. Get supplements that are single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

 

 

 

Edited December 4, 2020 by Gridley

[Camille]

Thanks Gridley for your reply !

I see that you have successfully tapered Lexapro. Did you use the liquid version to do so or a pill cutter? I tried the liquid version last time, taking 10 drops (for 10mg) and it didn't have any effects, it was like i didn't take the med (I had my usual headache that i have when i forget to take my med) so i had to take my usual pill. Is it possible that the liquid version would not work on me or was it just this one product that was defective? Also I'm worried that when I cut pill into very small bits, it might loose its effect because of some digestion process that would just make the micro pill ineffective? Am i being crazy to think that or is it possible that pills loose its effect when cut too small? 

 

[Gridley]

3 hours ago, Camille said:

a pill cutter?

I used a digital scale and weighed powdered tablets crushed between two spoons.  I added/subtracted powder as needed to get my dose using a little spoon available on Amazon.

 

3 hours ago, Camille said:

the liquid version would not work on me

The liquid version does not work for some people.

3 hours ago, Camille said:

Also I'm worried that when I cut pill into very small bits, it might loose its effect because of some digestion process that would just make the micro pill ineffective? Am i being crazy to think that or is it possible that pills loose its effect when cut too small? 

Crushing pills to powder is a well-established method for tapering, and I've never heard of this as a problem.  

[Camille]

Ok Gridley thanks a lot, I'm reassured 😊

[Camille]

53 minutes ago, Gridley said:

I used a digital scale and weighed powdered tablets crushed between two spoons.  I added/subtracted powder as needed to get my dose using a little spoon available on Amazon.

What was the brand of the digital scale you used ? Was it accurate up to the tenth of a miligram ? 🤫

[Gridley]

9 minutes ago, Camille said:

What was the brand of the digital scale you used ? Was it accurate up to the tenth of a miligram ? 🤫

I used (and still use) the Gemini-20 scale available on Amazon.  By using the 10 gram weight that comes with the scale, I found it accurate to 1mg pill weight.  Because there's so much more pill weight (because of fillers and binders) than active ingredient (dosage), I was able to to measure to around 0.5mg or less active ingredient   

 

Others have found the scale accurate to only 4mg pill weight, after which they had to "eyeball" their measurement by dividing it manually.

[Camille]

Hello everyone !

I'm taking 10mg in pill and i want to start taking it in water to prepare for my future taper (I'm planning on using the titration method), so by dissolving my pill in a glass of water and of course making sure that i rinse and drink the entirety of the dissolved pill. I was wondering if anyone has reported that dissolving Lexapro pill in water could alter/reduce its efficacy ? Or that most people had no problem with it and didn't notice any major difference in efficacy ? 

Thanks in advance for any reply.

[Yesyes123]

@Camille hello! It would probably be better to get the liquid form instead of dissolving the pill. We can talk more about this later - and surely the mods will help too. I plan on switching to liquid too this year so I can start tapering sometime. Peace and healing

[Camille]

Hello Yesyes123. I already tried the liquid form bought at the pharmacy and it did not work at all, it was like I did not take my med, I had my classic interdose withdrawal headaches and i had to take my normal solid pill. I tried it twice and both times it didn't work. Sure it could have been this one liquid bottle that was not working but I feel you have more control when you make your own liquid, and I've tried it and it seems to work very well. Right now, I'm at 8,75mg (solid form). I feel ok but still "anhedonic" (if that word exist), that's why i upped my dose. I tried going all the way up to 10mg but I started having insomnia (although my mood was pretty good) so i had to stay at 8,75mg. I think I did too much change on my dose on a short time, now my plan is to not change anything until March. In march, if I still have "anhedonia", ill slowly convert my med into a 100% liquid form (at a speed of 1,25mg/2 weeks) and then I'll analyse the situation again when this is done. But I've come to realize and accept how slow of a process this is and that i have to be extremely careful every time i make a move because the risks are too high and you can't really go back (like I felt great on 10mg last August and when I tried 10mg again in January I had insomnia). I'm also trying Intermittent fasting again (already did it before and it did wonders for my fatigue) because I hear it can help with brain plasticity.

[Yesyes123]

@Camille thanks for your response. When you were switching from pill to liquid, did you do it very slowly? Like one week 3/4 pill + 1/4 liquid, then one week 1/2 pill 1/2 liquid etc ... or how did you make the switch? Also what brand liquid escitalopram did you use? Thanks

[Yesyes123]

How are you taking 8,75mg? Splitting pills?

[Camille]

54 minutes ago, Yesyes123 said:

How are you taking 8,75mg? Splitting pills?

Im cutting a 15mg pill in half (so 7,5mg) and a 5mg in 4 (so 1,25mg). I use a pill cutter to split the 5mg, it's a bit difficult but reasonnably accurate so I'm satisfied with it.

 

2 hours ago, Yesyes123 said:

When you were switching from pill to liquid, did you do it very slowly? Like one week 3/4 pill + 1/4 liquid, then one week 1/2 pill 1/2 liquid etc ... or how did you make the switch?

No, I switched all of a sudden and I should not have done it that fast. Nonetheless, my observation is still accurate : it was very apparent that the liquid form had no effect whatsoever on me. Not doing a transition into liquid, though it can have some kind of noticeable effect on you, is not supposed to result in a total loss of effect of the med. Who knows, maybe it's because I did not shake it enough and all of the "active substance" was at the bottom (don"t know if that's a real thing) or maybe it was not well preserved in the pharmacy, but it really was like taking nothing at all (this I know because i always have the same sensation of headache and dizziness when I'm late taking my med aka "interdose withdawal")

 

2 hours ago, Yesyes123 said:

Also what brand liquid escitalopram did you use?

My pharmacist will occasionally change the brand of the med and I don't mind because it doesn't make any noticeable change on me. Right now, the 7,5mg part of the pill is from a brand called " Biogran" and the 1,25mg part is from "EvoluGEN". The liquid form I tried a couple month ago was "Seroplex" (so the originator brand). By the way, I'm French so all these brands might be only available in France.

[Yesyes123]

Thanks for the response - do you feel that probiotics are helping?

[Camille]

1 hour ago, Yesyes123 said:

Thanks for the response - do you feel that probiotics are helping?

  Saying they were a miracle to me would be an understatement. I'm convinced that probiotics cured my severe cystic acne (I literally stopped having new pimples after 3 days of use, I know it seems crazy and I really took time to make the link because it seemed crazy to me too) and was the reason I felt so good and happy for the first time in my life last August/beginning of September (some might argue that it may have been the 10mg of ADs starting to have effect but I don't think so because I took this exact same dose back in April 2020 and I did not feel the same way at all).

  Unfortunately, probiotics can't do much against antidepressants withdrawal. Of course, all of these are just observations from my personal experience, but these observations are all backed up by a lot of scientific studies so they're not completely absurd. According to some scientific papers, depression is not a "neurological" disease (except when it's depression that is a consequence of WD from ADs, then it becomes indeed some form of chemical imbalance induced depression), but a disease that is a consequence of an unhealthy gut. Anyway, I want to share this knowledge to other people but at the same time I don't want seem like some kind of crazy preacher for a probiotics cult.

[Camille]

Interesting Update : In February, I started the process of converting my solid med into liquid. Initially, I wanted to go this way : every week convert 1,25mg into liquid until total. After 1 week, when I started converting 2,5mg into liquid, I began having symptoms that I usually recognize when "overdosing", which were insomnia, anxiety, sweating, difficulty swallowing, trouble with my vision. So i concluded that the liquid form was more "powerful" than the solid one and little by little, after some experiments (that were probably pretty risky in retrospect, but also the overdosing symptoms were pretty nasty) it led me to figure out, based on my physical symptoms, that the appropriate dose in liquid form for me was 3,5mg.

My plan : I plan to wait 1 week to reduce my dose by 0,5mg, I know that it's more than the recommended 10% but I'm actually trying to make sure that the process of extraction with the seringue is actually working. So by decreasing by a substantial amount, I am voluntarily provoking some hopefully mild withdrawal symptoms that will make me know for sure that the process is indeed working. After that, I'll follow the 10% rule.

[Camille]

A theory to explain why the liquid form is so much more "powerful" is that when the med is dissolved in water, some of it is directly absorbed through the mucus is your mouth (and other mucuses) right to your bloodstream. Whereas when you take the solid form, it only starts dissolving once in the stomach and then go through the liver. We can imagine that the liver transform or get rid of some of the substance, making it less powerful.

The reverse actually happens when consuming cannabis. When you smoke it, it goes right through mucuses in your lungs into your bloodstream. The effect arrives fast and also goes away fast and the "high" is not super intense. "Eating cannabis will give you a much stronger high compared to smoking. The reason behind this lies in the manner in which THC is processed by the body : THC metabolises into 11-hydroxy-THC if it enters the body through the stomach and liver. This metabolite has a much higher affinity for CB1 receptors in the brain, making the hit a lot stronger". (https://www.royalqueenseeds.com/blog-smoking-weed-vs-eating-weed-what-is-the-difference-n455).    

 

[Camille]

Hello again : I was wondering, has anyone else ever done/is doing a water titration method with Lexapro ? I'd like to know about their experience just to be sure I'm on the right path !

 

[Yesyes123]

Camille, it seems like you are doing a lot of experimenting and doing things which differ from SA's advice, right? 

 

I truly hope you are right that 3.5mg is the right dosage for you, but that sounds like a VERY big drop from your previous dose. It honestly sounds a bit scary to me. There shouldn't be such a big difference in potency from the liquid to solid, if any at all? 

 

At least, not that I ever read about. @Gridley might be able to assist us.

 

I truly wish you the very best, and please keep posting your progress!

 

Also, are you just putting your 10mg Lexapro pill in 10mL water and waiting for it to dissolve? How long does it usually take to dissolve?

 

Peace and healing

[Camille]

Btw, I forgot to mention that when I couldn't sleep when I was back on 10mg in January and that I had what I think was an "overdose" (of serotonin maybe ?) , I tried melatonin and it really made me feel worse. So melatonin is not just a completely innocuous molecule. IMO, any substance that is potent enough to actually have a noticeable positive effect on some people, can probably also have some noticeable negative effects on some others. 

[Camille]

So now, my main symptom since September 2020 is anhedonia (this obviously goes with absence of sexual pleasure) although my mood is generally pretty good + underlying constant anxiety (high resting heart beat, around 90). A new symptom I have is ear clicking/crackling when I walk. I have interdose WD around 2 hours before I take my med (headaches, dizziness, light sensitivity, vision disturbances) but they are also triggered after exercise.

I have a hard time discerning which of these symptoms are caused by the meds themselves, by the WD or are part of the original disease.

[Camille]

Update : Since end of April, some feelings and emotions are slowly coming back, I cried a few times (I had not cried in about 9 months or so) and I am so happy to be able to cry again, it really feels good.

 

[Camille]

On 3/5/2021 at 2:22 PM, Yesyes123 said:

I truly hope you are right that 3.5mg is the right dosage for you, but that sounds like a VERY big drop from your previous dose. It honestly sounds a bit scary to me. There shouldn't be such a big difference in potency from the liquid to solid, if any at all? 

Hey I know that seems crazy, but not impossible! When dissolved, the med is absorbed "buccally" (like directly into the blood through the tissue in your mouth). When you swallow it, it goes through a completely different system of absorption (through your digestive system and liver). 

 

On 3/5/2021 at 2:22 PM, Yesyes123 said:

Also, are you just putting your 10mg Lexapro pill in 10mL water and waiting for it to dissolve? How long does it usually take to dissolve?

 

I put 3,75mg of med (3 quarters of a 5mg pill) in 150mL of water. It generally takes about 10-15 minutes to dissolve. IMPORTANT : Not all brands/generics dissolve in water. I tried a different brand than the one I usually use and it would not dissolve, no matter the quantity of water I put and the time I waited !!

[Camille]

The dilution ratio I use is 2,5mg for 100mL of water, so 1mg for 40mL of water.

[Camille]

Hello, so I'm bumping into some difficulties. I'm currently using the titration method for my Lexapro taper and taking right now 120mL (so the equivalent of 3mg solid). Ive been on this dose for a month now with no WD symptoms (except dry eye and vision disturbances but I think they are due to the med itself more than the WD/ and waking up very early at the beginning and then my sleep got more regular). I tried to decrease by 2mL, which is a really super small drop and the WD symptoms were hard : insomnia and anxiety and crying spells, I went back to 120mL immediately. How can i be sensitive to such a small decrease ? Is this some kind of threshold that I have to go through and then it will be easier ?(I heard that ADs are threshold meds, like they won't do anything until a certain quantity and then when you've reached that certain point they start working, so I could be experiencing the same but in reverse). Like maybe it's a difficult passage where you brain goes through a major change in his functioning (like the dopamine system wakes up)? Because basically if it's gonna be that hard everytime I  decrease by 2mL, it's gonna take me 20 years to get over this taper. Is there such a thing as a "hard passage" in a taper, where it's very hard to decrease at some point but then it gets a bit easier ? I know it goes against the saying that every drop is harder because it's a higher percentage but still I'm wondering...

[Yesyes123]

I'm confused about what you're doing - you're taking 120mL of Lexapro liquid with 3mg active ingredient? 

 

Are you making your own liquid by dissolving the lexapro pills in water?

[Camille]

 

[Crochet]

Thank you for posting that video.  I was hoping she would share more about her and her father's experience with antidepressants.

[Dee12h]

I think that’s a myth about AD’s. I’ve only been on 2.5 mg max & definitely felt it! I’m only on .7mg now, and I have side effects from it every day. I’m sleeping fine. Everyone’s different, though. Did something else happen around the same time you lowered your dose?

[Camille]

 

16 hours ago, Crochet said:

Thank you for posting that video.  I was hoping she would share more about her and her father's experience with antidepressants.

Your welcome  

14 hours ago, Dee12h said:

I think that’s a myth about AD’s. I’ve only been on 2.5 mg max & definitely felt it! I’m only on .7mg now, and I have side effects from it every day. I’m sleeping fine. Everyone’s different, though. Did something else happen around the same time you lowered your dose?

Hey thanks for answering  Yeah honestly it's impossible to make sense of how these meds affect us. No, nothing else happened but the day before yesterday, I decided to take my meds in the morning instead of at night and now i'm able sleep ! It really doesn't make sense because I was sleeping fine before and I was taking my meds before sleep but anyways I'm gonna stop trying to make sense of all of this because honestly whatever is happening in my brain is probably super complicated.

[Yesyes123]

On 5/22/2021 at 6:42 AM, Camille said:

 

 

Awesome. Has anyone heard of this "lion diet" she says basically saved her from WD?

 

@Altostrata do you know anything about this?

[Altostrata]

On 5/20/2021 at 10:06 AM, Camille said:

I tried to decrease by 2mL, which is a really super small drop and the WD symptoms were hard : insomnia and anxiety and crying spells, I went back to 120mL immediately. How can i be sensitive to such a small decrease ? Is this some kind of threshold that I have to go through and then it will be easier ?

 

How old is your liquid? When does it expire?

 

3mg is a very small amount of escitalopram, but it has about 20% receptor occupancy. There is no such thing as a "therapeutic dose" when you're decreasing the drug. Obviously, if you get withdrawal when you decrease, the drug has some effect on you.

 

Often the last little bit is the most difficult. You may wish to stay at 3mg per day for a good while, perhaps a couple of months, to let your nervous system regroup before making further decreases.

 

 

[Camille]

Reporting yet other weird stuff happening with tapering (I'm doing that for informational purpose, for anyone who might feel similar stuff) : So I am now taking my AD in the morning instead of at night and am now able to sleep (Weird?). BUT now I have AD toxicity symptoms-!and not WD!- (something I could only describe as mild akathesia + hard time having thoughts in my head). I had the same thing last January and reducing my dose helped a lot so that's what I did. I think I didn't reduce enough because the toxicity symptoms are still present BUT (still weird) just a few days ago I published here saying that I was kind of hopeless because I had reduced my meds by only a very very small amount and I could feel it (insomnia and increased anxiety and crying spells), I just decreased by way more and don't have any WD. I just found a thread on this website of people experiencing similar stuff :    

 

[Camille]

By "way more", I mean by 5% of my current dose which isn't a whole lot. It didn't relieve me of what I think are toxicity symptoms from the med so I'm gonna try a 10-15% decrease instead.

[Yesyes123]

Hey! The actual effects of a dose reduction (or any alteration) usually can't be felt immeditately. It takes at least 4 days, sometimes a lot more, for effects to be felt. It seems to me the effects you felt from the small reduction might have been from something else...

 

Check this out

 

 

 

Peace and healing

 

[Dee12h]

I feel better after reducing as well. The meds make me really tired, irritable, & have brain fog. All that gets better with reductions, and then insomnia & anxiety go up some. It’s a balancing act.