stedder: reinstated escitalopram 2.5mg after being on citalopram/escitalopram for 20+ years, withdrawal syndrome

[stedder]

i was first prescribed citalopram about 2001 (i believe) for depression and anxiety. then switched to escitalopram when it became available as a generic drug. i have thought about getting off this medication for years, but wanted to do it as safely as possible. i tapered from 10mg to 5mg for 21 days, then 2.5mg for 21 days, then ~1.25mg for 10 days (but at this point i was splitting a 5mg pill into fourths and it was very inexact as the pill would split very unevenly). after going off completely i was experiencing bad withdrawal, horrible insomnia, extreme lethargy, depression, anxiety, suicidal ideation. after struggling with this for 2 weeks i reinstated at 2.5mg of escitalopram and have been on this for 6 days so far. insomnia isn't as bad, suicidal ideation isn't as bad, but still very lethargic with no motivation, and heavy anxiety, particularly regarding my job which has shifted completely to new responsibilities during covid. i feel like i can't handle it and just want to quit quit quit. i have a tendency to a flight instinct when something is causing me trauma, i just want to get as far away from it as possible. i just want to be able to continue working through January and see where i am then. i want my life not to be completely wasted in wasted days of marking time and taking naps and dreading work. i wish i could see the dopamine and serotonin levels in my brain and just set them correctly. i've come to feel that every joy comes at the price of a rebalancing of brain chemistry levels with an equal measure of suffering. is withdrawal syndrome just your body trying to rebalance (in my case) years of SSRI manipulation by setting my levels so low to reset me at a lower level? i'm glad to find a place where other people are talking about these things. thank you if you've read this.

[DataGuy]

Hi @stedder,

 

Welcome to SA. I'm sorry you had to experience that. Sounds like you tapered far too fast, so no surprise you felt terrible after coming off. You did the right thing in reinstating. If you are doing better on 2.5mg then that is great. I would hold there and avoid decreasing or increasing unless something changes substantially for the worse. Hopefully the symptoms continue to improve and you start feeling a bit more stable.

 

I don't think anyone knows exactly what is happening biologically in withdrawal syndrome, but we can be fairly confident it is not just a "rebalancing of chemicals". If that were the case then reinstating the correct amount would solve the problem every time. But for some people reinstating doesn't help or makes things worse. So when someone reinstates and it improves their condition, we are happy to leave them there until they feel more stable. Moving the dose up or down from there is usually just asking for trouble. 2.5mg is 25% of your original dose, so probably a fairly good reinstatement target. Here is most of what we know about reinstating, if you want to read about it.

 

It can take a long time for your nervous system to adapt back to normal after experiencing an acute withdrawal state like the one you did. Most people settle into a PAWS (post-acute withdrawal syndrome) state of varying intensity which gradually fades. Symptoms can include increased sensitivity to stress, anxiety, dizziness, fatigue, light and sound sensitivity and sleeplessness, among many others. 

 

I would suggest reading our topic Why Taper By 10% for your future escitalopram taper. Tapering slowly helps minimize both symptoms and symptom severity, ensuring you can remain functional while you get off the drug. Reducing more quickly than 10% can be too fast for many people, and as you get to lower doses you may want to slow the reduction even further, since receptor occupancy of these drugs tends to decrease more rapidly at lower doses. Here are specific tips for tapering off escitalopram.

 

Some drugs and supplements can interfere with metabolism and can also have psychotropic effects (antibiotics, steroids, some supplements, coffee, nicotine etc.). It would be very helpful if you could create a drug history in your signature like this one. This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

This will allow any moderator or member to quickly see your history and where you are in your taper, and thus be able to help more easily without too much reading (most people here are volunteers and have other jobs).

 

In the meantime, you might find some of these non drug coping techniques helpful to ease your symptoms. Hope you start feeling better soon : )

Edited September 14, 2021 by DataGuy

[stedder]

thank you very much for your thoughtful reply. although i am doing better on 2.5mg than i was completely off, i am still experiencing depression, lethargy, lack of motivation, and some insomnia. i am taking a nap every day and sleeping in late when i can, having shifted my work schedule later. i live somewhere where it is still hot and i hate the heat and can't afford a gym membership and don't have the motivation to exercise indoors somehow. from my internet research such as it is i am convinced i am short of dopamine and of course want a quick fix.

 

i am doing better than i was as i think my anxiety is slightly reduced, i have less suicidal ideation, my insomnia isn't as bad, and my brain zaps are gone. i certainly would have tapered in 10% increments if i had found this site sooner. i was particularly depressed yesterday due to my doctor not forwarding bloodwork results to my endocrinologist and finding them now billing me for something from 2020 that they claim my insurance didn't pay back then. there are so many doctor's office mistakes and insurance billing issues and surprise expenses it makes me want to not even bother dealing with the medical profession, though i certainly value science.

 

most of my life at the moment consists of just marking time, unable to utilize it to some more meaningful purpose. worrying about work. sometimes i just distract myself with streaming channels or sleep.

[DataGuy]

Ok @stedder, that is great that you are doing better on the 2.5mg of escitalopram. Excellent also that the brain zaps are gone. I think the best thing that you can do right now is to continue holding as your nervous system stabilizes and heals. You are definitely heading in the right direction. Just need to let things settle down and start to rebuild your activity. 

 

Yes, tough to exercise when it is hot out. I guess the best time to go out is very early in the morning, or late at night, but the heat can still be pretty excessive. I agree that exercising inside can be difficult. Best to just start off slow and build up. Just try doing a few pushups or situps to start out. I think it is the getting started part that is the hardest. You might find it useful when you get into a 'fight or flight' state to do some exercise to get rid of the nerves. This helps to channel that energy into something productive and exercising regularly might aid in lessening the instances of fight or flight in situations where you don't want it to happen. There is also meditation, deep breathing, progressive muscle relaxation and other techniques suggested in the non-drug coping tips link. You might find that exercises which relax you or lessen your anxiety will also make other symptoms better, like insomnia and depression. 

 

Please let me know if you run into any problems or have any questions : )

[stedder]

i really wonder if i need to increase my escitalopram dosage as i need something. i have no motivation or belief in my own life or actions. i am tired and find it very difficult to get out of bed and am scared of the anxieties of my job. i understand none of you are doctors and i don't mean to put pressure on you. i guess this is just documenting where i'm at. in researching how i'm doing it seems that i am very low on dopamine. i can't motivate myself to do anything.

[DataGuy]

Can you tell me why you think you are short of dopamine? 

[Altostrata]

You are only a couple weeks out from severe antidepressant withdrawal syndrome, from which it may take months to recover. Is that enough of an explanation why you don't feel tip-top?

 

As @DataGuy suggested, getting some gentle exercise may help you feel better, stronger, and more confident. Do what you can every day, get out there in a park or somewhere calming. Don't overdo it. This can help you recover.

[DataGuy]

Yes, as @Altostrata said, there are many explanations for your symptoms. The chemical imbalance theory has never really been proven, largely a marketing ploy created by pharmaceutical companies to sell their products. But if you wanted to test whether low dopamine is the cause of your problems, you could always take an ADHD med like Ritalin (not recommended) or a supplement like tyrosine or phenylalanine, which will both convert to dopamine eventually. But I suspect these things would make you feel worse rather than better. 

[stedder]

i've been trying to exercise a bit more. averaging two 15 minute walks per day, once earlier and once after the sun begins to set. i still have no motivation and find it difficult to wake up. my depression tries to tell me that my problems are due to the pointlessness of life and the eternity and randomness of death. but i only feel this way when the chemicals are aligned this way. i am keenly aware that changing the chemicals changes my mental state. we are all in difficulty after all due to the effects of these chemicals on on bodies and brains. it seems most people in this group seem to need to go back to some kind of chemical mediation of their condition. it is just hard to find the right treatment and diet and exercise, etc.

 

i don't have access to Ritalin, but i found some L-Tyrosine and have been trying 1/4 tsp of that powder earlier in the day. i'm not certain, but i think it makes some difference. i'm desperate not to just pass the time as days go by, but actually function and do things that have meaning for me. i've always been a night person and for some reason can't read during the day as it feels too passive to me. i feel like i need to be alive somehow more. but at night i am able to "settle for" and enjoy reading as long as i'm not slogging through a book i can't maintain interest in. i'll look into phenylalanine. i had planned to go on a road trip before Delta go so out of hand in the US and have cancelled the trip, but still am taking my vacation days and really wish i could make use of this time. thank you both for your comments.

[DataGuy]

Hi @stedder,

 

No need to look into phenylalanine as that is just a precursor for tyrosine. If you cannot tell it is having any effect, it is possible it is a placebo effect. Very common with psychotropics. In the trials for antidepressants, placebos account for more than 80% of the benefit observed and antidepressants only have a tiny benefit. See this article.

 

"The mean difference between antidepressants and placebo on the 17-item Hamilton depression rating scale (range 0–52 points) was 1.97 points (95% CI 1.74 to 2.21)."

 

If chemical remediation was needed for people with depression, you would expect to see a much more dramatic benefit. People on this site are mostly suffering from withdrawal, which, yes, may be in part a sort of chemical imbalance, but is also partly an injury which can take months or years to heal. If it were purely a chemical imbalance it would be an easy fix. That being said, you are free to experiment as you like, but just a warning that people suffering in withdrawal tend to have an elevated rate of adverse reactions to all kinds of things, including drugs and supplements. Sometimes they will find something that works but then stops working or causes an adverse reaction after a few days or weeks. Taking anything with psychotropic effects long term tends to just cause the brain to adapt to the chemical, so people may experience a placebo effect upon initially taking the drug, mistake this for a drug effect, and then continue taking the drug and become dependent on it. Withdrawal is then mistaken for relapse or "a chemical imbalance" and tends to just result in neverending antidepressant use that is mostly unnecessary or harmful. But I think you will have to convince yourself that this is true through experimentation and reading. 

 

 

 

 

[stedder]

are sad journal entries allowed here as a document of ones state of being?

the journey continues. watching things on streaming media that are too stressful late at night and tried to begin a taper off kratom (so that i could use it again in the future effectively a couple of times a week instead of nightly to sleep). so i wasn't able to fall asleep until around 5am this morning, sleeping in the living room so my wife and i wouldn't disturb each other's sleep. still have no motivation and am too tired. it had gotten a bit more comfortable temperature-wise here, but has gotten hotter again making outdoor activity unpleasant. did take a nap like 3 days last week, but needed a nap yesterday which i'm sure added to my insomnia last night. will definitely try not to watch such stressful things late at night. am reading the Queen's Gambit which i probably like too much before bed which could contribute as well. still on vacation from work, but really dreading the resumption of my tasks on wednesday. don't know if it's suicidal ideation per se, but have decided that the only way to do it is quickly without thinking, ruling out pills and things slow to act or that involve too much awareness and passage of time in the process. i can't spend time on social media, especially reddit and areas where there are so many toxic comments. webpage headlines/links are all geared toward making us scared or clicking out of morbid curiosity.

i got on psych meds 20 years ago or so to help the fact that i don't deal well with stress and bad situations. still on the 2.5mg escitalopram as per my signature.

[stedder]

i hope it won't get me kicked off this site, but i may go back on 5mg of escitalopram up from 2.5mg. i really do think that my meds have probably kept me alive over the past 20 years. i don't know if i'm in a minority for whom they may serve some purpose or if that purpose is perhaps hard to measure effectively. my problem before being on meds is reacting badly and sinking into dangerous lows and suicidal ideation. i haven't been doing well the past couple of days. i had tried 1/4 teaspoon of L-tyrosine once or twice a day, but usually only once and i don't think i even took it every day so i don't think it is due to that. i think i'm going to go from 2.5mg to ~3.75mg and then to 5mg over a period of a couple of weeks, or should i take more time than that to reinstate at that level? i just need to see if my moods stabilize as i am in crisis and am considering quitting my job, etc.

[DataGuy]

Hi @stedder,

 

Are you taking anything else like Kratom? I need you to put that stuff in your signature. How fast have you been tapering the kratom? This could definitely make you worse as it has action at multiple opioid receptors and this can be pretty rough, especially if you've already been through at difficult withdrawal. How long were you taking the kratom? What dosage were you taking and what dose are you on now?

 

Best to put all supplements and drugs (really any non-food items you take regularly) in your signature. Some things people don't think have pharmacological effects actually do and can affect people with sensitized nervous systems more negatively than others. Do you drink coffee, smoke, drink or anything like that? I would just quit with the tyrosine if it's not making a substantial difference. It could also be making your worse. 

 

 

[stedder]

still so, so tired and unmotivated. planning on quitting my job in new year and see if that stress absence will change things. thinking very seriously of reinstating escitalopram to 5mg. i think my wife is a getting a bit tired of my depressed slothfulness. trying to exercise more. the only good, stable thing in my life is watching shows with my wife in late evening and then reading before bed. i'm eating enough, but food doesn't really interest me, even foods i "love".

[DataGuy]

Thanks for the update @stedder. Did the increase in dose of escitalopram help? Any adverse effects?

 

Please let me know the dose of Kratom, your starting dose and how quickly you tapered, when you get time. 

 

Things should get better the further you get from your rapid withdrawal, although this may be contingent on not adding more drugs, or changing doses of other drugs or supplements. 

 

[stedder]

hello @DataGuy, i updated my signature with my kratom info. just a half a level teaspoon late evening to help me sleep which i've been doing for a couple of years as i had bad insomnia before that. i was going to try to wean off that too, but will wait till i'm more stable. no adverse effects with escitalopram at 3.75mg, but still no motivation and depressed. the weather is finally getting cooler so i'm hoping that will help me come back to life. thanks and best wishes.