Mascasa: Oral Lexapro taper

[Mascasa]

@DataGuyI went back to 5 mg on Thursday. Felt okay yesterday. A bit nauseous today. I checked on taking Pepto Bismo with the Lexapro seems to be okay to do?

[DataGuy]

@Mascasain general I recommend making very scarce use of supplements and over the counter products, just because most of them have very little proven benefit and can be harmful in some instances. 

 

There is a bit of an interaction between pepto-bismol and escitalopram. As you can see here,

there is a moderately heightened risk of bleeding. You can still use it, but best to be cautious about it. 

[Mascasa]

@DataGuyi had read that about the bleeding.  Just tummy hurts today. I know things are probably readjusting to 5.

[Mascasa]

@DataGuyI have a question about surgery and tapering. I am in need of a SI fusion. I am leaning towards doing it. I know there will be pain meds short term. Thoughts? I have been in a lot of pain these last few years.

[DataGuy]

I will try to look into it over the next few days. Please remind me if I forget.

[Mascasa]

@DataGuyThanks.I think if I had done something about 3 years ago I wouldn’t even be here on the site. The lack of walking or being able to sit caused a lot of anxiety 3 years ago.it’s getting where I have a hard time sleeping or sitting.

[Heath]

46 minutes ago, Mascasa said:

@DataGuyThanks.I think if I had done something about 3 years ago I wouldn’t even be here on the site. The lack of walking or being able to sit caused a lot of anxiety 3 years ago.it’s getting where I have a hard time sleeping or sitting.

I am rt there with you on this. Can’t stand or sit still for 5 minutes. The longer I do the longer the hard walking and pain will stay in waist, hips, legs and feet. Was told mine is L5/S1. 22 years ago Dr put me on Paxil for this. 🙄 As I was too young for risky fusion. I try not to think about it but, my wife and I talked about it today. 
 

My dad had gotten to where he couldn’t walk and had a second back surgery a month ago and he is walking 3 tenths of a mile now
 

I think we have talked about this some before. I am sure you have applied all self help for the SI inflammation and pain. I recently started try cold water therapy and cold showers. Seems to be helping with the pain some. 

[Mascasa]

2 hours ago, Heath said:

I am rt there with you on this. Can’t stand or sit still for 5 minutes. The longer I do the longer the hard walking and pain will stay in waist, hips, legs and feet. Was told mine is L5/S1. 22 years ago Dr put me on Paxil for this. 🙄 As I was too young for risky fusion. I try not to think about it but, my wife and I talked about it today. 
 

My dad had gotten to where he couldn’t walk and had a second back surgery a month ago and he is walking 3 tenths of a mile now
 

I think we have talked about this some before. I am sure you have applied all self help for the SI inflammation and pain. I recently started try cold water therapy and cold showers. Seems to be helping with the pain some. 

@Heath Yes I am getting worse. I have had one surgery 30 years ago. Those same discs L4/5 and S1 aren't good right now. But from what we are gathering it is my SI joint. I have spent the whole afternoon researching things. I am impressed with the Mayo Clinic. But would be quite the ordeal for me to get there on a plane. I am seeing a surgeon at UCSF that is quite good and already talked to one of his patients who is back to scuba diving. So I am not going to wait around much more. I am going to move ahead and do something.

[Altostrata]

Hello, @Mascasa, how are you feeling with a slight updose?

 

If you need surgery, you'll have to trust in the doctors and accept the risk.

[Mascasa]

@AltostrataYes, I am feeling a bit better with the updose. Still a bit of an upset tummy. But nothing like last week. Hoping each day it gets better and better.

I am planning on waiting for a good long while and not make anymore tapering moves until I feel way more settled.

Yes, definitely think highly of the surgeon and hope in the long run it gives me a better quality of life.

Thanks for checking in.

[DataGuy]

@Mascasa, in terms of the withdrawal aspects of surgery, there have been plenty of people who have had surgery with anesthetic on this site and they recovered ok. It may result in a temporary setback, but most recover within a few days or weeks. The pain meds are always just there to be taken as needed. If you can avoid taking them, or take fewer, that is generally preferable. 

 

As Altostrata noted, the risk vs benefit of the surgery is not something I am an expert in. When I want to know about a particular medical procedure I generally look it up on Cochrane reviews. They will have a plain language summary that is easy to understand if they have reviewed the procedure. If it isn't there, I will look up a randomized trial to see what the benefits vs risks were. Beyond that, hopefully your doctor is providing accurate info. It's never a bad idea to seek out second and third opinions, though : )

Edited December 8, 2022 by DataGuy

[Deruyter]

On 10/5/2021 at 4:20 AM, Mascasa said:

@Deruyter over two months? Wow! How did you handle the withdrawal symptoms?

With the help of my psychotherapist, and also coping with the side effects. They started weaning off day by day. The only medication I was taking on a daily basis was lormetazepam 1mg to help me sleep. I also took maybe three or four tablets of alprazolam 0,5mg in a month when I had a very bad panic attack.

[Mascasa]

Okay need a bit of support. I am at 4.8 and holding there for 16 days from a very small % drop. Tried BM slide to get smaller %. Did okay until hitting the 4.8. So as you see my taper went back to 4.9 for a week, then back to 5mg. That's where I held for a bit then started again with BM slide and very small decrease.

So now 16 days of holding at the 4.8 and so low each and every day. This is my pattern usually. But never this long. I want to move ahead with my old taper of % drop and hold there for 4 weeks. So my question is give the taper drop a try and see if things move forward? I can add that I have a "mind set" about the 4.8 because it gave me trouble before. Any thoughts would be so great. I am so tired of tapering....

I am hoping the file opens to show the notes in my phone. 

@Altostrata@brassmonkey@manymoretodays

Edited February 2, 2023 by Mascasa
added a note about dates

[Altostrata]

If I were you, I would not taper again until those withdrawal symptoms go away. You might consider holding off tapering for several months. You decreased from 20mg to 5mg in 4 months. That's pretty fast.

[Carmie]

Hi there Mascasa, 
 

I totally agree with Alto, if you keep dropping when you’re already not stable it can really catch up with you down the track and then you’ll have to stop tapering anyway because the withdrawals might be really severe. It could take you a very long time to stabilise again. Been there, done that. Better to have a long hold now. 
 

Wishing you all the best 🤗

[Mascasa]

9 hours ago, Altostrata said:

If I were you, I would not taper again until those withdrawal symptoms go away. You might consider holding off tapering for several months. You decreased from 20mg to 5mg in 4 months. That's pretty fast.

@Altostrata I know my signature may not reflect it. But I am 1 year 9 months into the taper. Not 5 months. 2 years in May.

[Mascasa]

@Carmie I have been tapering since May 2021. So it will be two years this May. Not 5 months.

I was looking at your taper schedule. Can you explain a bit about how you are doing it?

[Carmie]

Hi @Mascasa

 

Hope you’re having a nice day. You were asking about my tapering. I’ve been tapering for many, many years and will be doing so for a very long time still. I was originally on 300mg of Seroquel and managed to get down to 7.25mg before I found this site. I won’t be jumping off these meds until I’m down to 0.00something. I am extremely sensitive to the smallest of reductions. 

 

The lower I go down though the smaller the drops. It’s taken me from March 2019 until now to go down from 7.25mg to 3.50mg. I can’t taper very quickly or the symptoms get so severe. I don’t want to get Akathisia again as it’s the most awful thing I’ve ever experienced. 
 

The last two drops I’ve done have only been 1.5% or so and I’ve held them each for seven weeks. I listen to my body. I learnt on this site that I can water titrate the Seroquel, thus I’m able to go down slowly. I’ve gone down by 0.05mg the last few drops. 

A lot of people can taper down by 10% every month, but then there are others like me who can’t do that. Everybody is different. 

Wishing you all the best in your journey of getting off these meds💛

[Mascasa]

@CarmieThank you for responding. I appreciate you sharing your journey. I may have shared before I was only on lex for 1 year 8 months. So very discouraging when you have to spend almost two years to get off. Mind me asking how long you were on your Seroquel?  So you are going down by 1.5% and holding for 7 weeks. Do you have any symptoms doing that? WD? 

[Altostrata]

No matter how you've been tapering, if you get withdrawal symptoms, you may wish to stop tapering for a good while, or consider a small updose since you've had difficulty at 4.8mg before.

 

We know the very last part of the taper is more difficult. It appears 5mg might be your "oh-oh" point, when SERT occupancy curve gets very steep. See

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

Discussion of a scientific journal article with data supporting a very gradual taper.

 

We have seen that often when people hold at one dose for some months to allow withdrawal symptoms to go away completely, that gives you a better ability to inch your way down the steep part of the curve. 

[Mascasa]

@AltostrataThank you so much for your response. I have been hanging in there lots of lows throughout the last almost 2 years. This taper drop definitely has taken the cake. So to make sure i have a game plan. Go back to 4.85 for a bit and just hang on there for awhile until things settle down?

I know I do stew on things too. I will fixate on where others are and why am I not there? etc.  I know when I went to 4.8 the 2nd time I thought "uh oh". So I kinda set myself up. But symptoms are still hanging around. Tough to work in education and feel like crying each day. 

Again thank you for support. I am hoping the hold will allow me to get down that hill.

[Altostrata]

1 hour ago, Mascasa said:

So to make sure i have a game plan. Go back to 4.85 for a bit and just hang on there for awhile until things settle down?

 

You could go back to 4.85mg, see if that's enough.

[Mascasa]

@AltostrataThank you again. I will see how 4.85 works. I thought 4.9 was okay if I remember correctly.

So a side question. You mentioned about the SERT occupancy curve which I am aware of. So my question is does that correlate to someone who had trouble getting on lexapro as well? I had trouble getting on it, and trouble being on it ( never really helped), thus problematic for me with that occupancy curve under 5?

Just wondering if there is a correlation.

[Altostrata]

What kind of trouble did you have going on Lexapro?

[Mascasa]

@AltostrataHad to start at 5 mg They wanted me to start at 10mg. Couldn't do it. So I crept up very slowly. Had symptoms all the way up and on 20 mg. Made me very low, crying, tinnuitis, some gi issues. Psychiatrist said it was a partial response? I decided in May of 2021 I was done. I started on Sept. 2019. Started to taper. Hit a hard part at 9 mg. Got very sick and dizzy. Then recently tried the Brass Monkey taper to see if creeping down a small bit would help. Did I think from 4.95 to 4.9, maybe 4.85. But not 4.8. Been holding for almost 18 days there. Never been on anything ever. Have always wondered if it has made me worse. Wasn't like this before being on it.

[Altostrata]

I see. You were prescribed Ativan to get you going on Lexapro?

 

That is not a partial response, that is a history of adverse effects from Lexapro. Your nervous system and the drug did not get along.

 

From what I've seen, people who have had difficulty with the antidepressant from the start may also have difficulty going off. Your nervous system has been fighting adverse effects for a long time. 

 

How do you feel after you take Lexapro every day, compared to how you feel before you take your dose?

[Mascasa]

@AltostrataThat's funny you should ask. I feel better prior to taking it. When I wake up I feel okay. Then I take it  after breakfast and well things kick in a bit. I think you are so right that my nervous system did not get along with it at all. I told the psychiatrist and their many interns that. Sigh.. I found an article by Mark Horowitz that stated something similar to getting on and getting off. I was going to copy and paste it here. I so hope that it won't be a battle. It's literally been 3 years of my life.

I did up dose to 4.85 today. 

The ativan was very short lived. Like 2 weeks and I got off it. 

So yes you are so right about me not getting along with it. So any advice thoughts etc?

I am going to be able to get off of this?

[Mascasa]

@AltostrataThe degree of adaptation to the drug for an individual could be quantified to predict the risk of withdrawal. Currently, the adaptations to antidepressants demonstrated in neuro-imaging of clinical subjects and in animal studies provide a plausible mechanism for withdrawal but we cannot draw definitive conclusions that this represents the underlying pathophysiology of withdrawal effects.

There are a few of the statements. But I am so hoping that it's not going to be totally me. I hope there is a bit of hope that I can get off this without a bunch of trouble. Makes me so sad to think all this time I have been taking something that didn't really work and may have put my CNS through heck. Have no choice but to keep pressing on. 

[Altostrata]

I was a co-author of that paper.

 

Since you feel better before taking escitalopram and worse afterward, my guess is you are still suffering adverse effects of escitalopram. I suggest you keep micro-tapering it.

[Carmie]

On 2/3/2023 at 5:47 AM, Mascasa said:

@CarmieThank you for responding. I appreciate you sharing your journey. I may have shared before I was only on lex for 1 year 8 months. So very discouraging when you have to spend almost two years to get off. Mind me asking how long you were on your Seroquel?  So you are going down by 1.5% and holding for 7 weeks. Do you have any symptoms doing that? WD? 

Hi there again Mascasa, 

 

I don’t remember how long I’ve been tapering Seroquel as it’s been forever. I didn’t keep a diary, maybe eight to ten years so far, I’m really not sure. I have memory issues too with my CFS so trying to remember things can sometimes be hard for me. 
 

I have been put on and off all sorts of things and my brain is extremely destabilised so I have to go quite slow. Not everyone will have to go as slow as me. Some are fine tapering at 10% every month. 
 

As regards to your second question, yes, I still get withdrawal symptoms no matter how slow I go. You can’t escape withdrawal symptoms because every time you make a drop your brain has to stabilise again and find some kind of equilibrium. 
 

Even before making the next drop I still have symptoms, but it’s my baseline and I know when my body is ready to taper again. 
 

Hope you have a pleasant day☀️

[Mascasa]

@Altostrata That is interesting! I so hope that I will continue to move down and off. Can  you please share  how you would suggest my micro tapering be? I don't want to do any more to upset my nervous system. I am at 4.85. Thanks. 

*Just had a big boo hoo over all this. Makes me so mad and sad that I took this and felt it wasn't working, but kept going. 

[Altostrata]

Did your problems with tapering start after you had that surgery in December?

 

Did you skip a dose to prepare for surgery? Did anything else happen to coincidentally cause an upset you attribute to withdrawal?

[Mascasa]

@AltostrataI elected not to have surgery. I had a conservative approach done this last Monday. Hoping to get some relief from it.  I  have been in chronic pain with back issues, foot, and ribs. Had scans for potential kidney things. But nothing wrong with kidneys.. I think. Back procedure on hold, and did a conservative procedure this Monday. I know I have a terrible mindset about lexapro, getting on, staying on, and now getting off. 

I researched on the site for the microtaper:

• For example, if you find you can't reduce 10% from 25mg -- 2.5mg -- without withdrawal symptoms, your micro-taper would be a fraction of 2.5mg, such as .5mg.

• Reduce your dose by the micro amount. Take this dose for a week.

Can you help me apply this to my dose of 4.85? I wasn't doing 10% I was doing about 5%. Me

[Mascasa]

@Altostrata I upsized to 4.85 yesterday. Felt ok. Today I am in tears. Went out to breakfast shopped holding it back the whole time ???

think I should go back to 4.9 or just wait into it at 4.85? Tired of crying and husband is trying but it’s hard on a marriage.

[Altostrata]

If it's just as easy to measure 4.85mg rather than 4.9mg, and 4.85mg works, why not just stay there? 

 

Please don't feel you've failed. You've decreased quite a bit. Have the adverse effects of Lexapro reduced since you were taking a higher dose?

[Mascasa]

@AltostrataYou are a blessing. Thank you for responding. I know you are so busy.

I can certainly stay at 4.85. It's a bit harder to measure. I reminded myself talking to another who is tapering that I did okay at 4.9. Guess I need to see how things go the next day or so. 

I know I am my own worst enemy. Feel like "why can't my body get off this?" etc. etc. So I literally broke today. I have just lost my direction and when ready how to continue the taper? Any guidance would be appreciated.

The 20 mg was not a friend of mine, with one exception. I was on generic until the month I thought to taper. May 2021. They put me on the real Lexapro and I did feel better. So who knows?

I do feel a bit like myself the lower I go, with the exception of all the crying and very low moods. Never had this before the Lexapro.

Me