lex1989: escitalopram / Cipralex and clonazepam / Rivotril / Klonopin

[Greatful]

@lex1989

I just saw your post on sunflower 414.  Thank you for encouraging her.  

Now tell about the CBD oil you are using and how it is helping you.  You sounded excited

Did you cut?

[lex1989]

On 11/19/2021 at 10:55 PM, Altostrata said:

@lex1989 you are in a difficult position. There's no good solution, you need to go off the drug fairly quickly and risk withdrawal syndrome. The clonazepam may be of help for some withdrawal symptoms. 

 

@Altostrata maybe there is a good solution, getting of this medicine that is provoking me adverse reaction in a faster way / taper would be better, I am saying this, because I feel better at 4 mg , than at 5m, not much better, but better.

 

I would much prefer to use medicinal CBD oil (taking just 5 mg x 1-2 times a week and I feel 100% normal when taking it, amazing) than to add benzos, because I am almost certain that I am in withdrawal from the Clonazepam as well.

I hit tolerance with it 3-4 months ago and did also a fast taper from 0.5 to 0.3 so...

 

On 11/19/2021 at 10:55 PM, Altostrata said:

You may be able to tolerate small reductions made more frequently (micro-taper), such as 0.10mg decreases every 4 days until you get to 1.0mg escitalopram, then 0.05mg decreases every 4 days.

 

Interesting approach , small problem here, my 2 x jewelry scales are not so accurate for me to do 0.1 mg decreases, I could do 0.2 mg tops. I was thinking to try a 0.5 mg cut on a 3 weeks basis, slowing down on last cuts bellow 1 mg(or 0.25 mg at a 1.5 week), following simple math, it's the same as your idea, ~ 6 months in both situations. What do you think ?

 

On 11/19/2021 at 10:55 PM, Altostrata said:

I hope this goes well for you.

I'm 100% certain it will. I'm not giving up no matter what 💪

[lex1989]

2 minutes ago, Greatful said:

@lex1989

I just saw your post on sunflower 414.  Thank you for encouraging her.  

Now tell about the CBD oil you are using and how it is helping you.  You sounded excited

Did you cut?

Sorry for late response to other 2 posts Grateful, I will respond here for them as well haha.

Sorry you had a rough couple of days, just after you had good ones, I remember when you said that you are excited doing the cut and you were good than bad again, it's "normal" in withdrawal.

 

Of course I am trying to help, why not, I don't want to see anyone on antidepressants again. This are probably the worst lies of medicines there is, much more harm than good. Completely not worth it. For normal stress cases, 2-4 weeks of benzo and that's all, people should not use psychiatric medicine if they don't have a really serious mental illness like dementia, epilepsy, schizophrenia, etc.

 

Related to CBD, it is just awesome, medicinal one (<0.2 THC), works like a charm to me.

As I have mainly anxiety provoked by the withdrawal from benzos and adverse reaction from A/D, the oil is taking it all away.

I usually have mild intrusive thoughts, fear truth the day and every time in the evening, 9-10 PM it is mostly gone. But I read this is mostly because of the cortisol provided by circadian rhythm and in withdrawal it's much intense, when in the evening it dissipates, but also I have adverse reaction from Lexapro, so yeah, it is what it is .

[Greatful]

@lex1989 How long have you been using it.  What brand/manufacture? 

How much do you use and is it daily?

My son and his wife use it and gave me some last winter but I was to afraid of trying it.  He researched it and came up with a 2 brands  I know the one he uses comes out of Colorado and has lot numbers on it to connect to the fields that it was taken from.  Organic, 3rd party tested. 

Blue Bird botanicals I  think the name was

 

You are feeling pretty good after your cut, when was that.   

Edited November 26, 2021 by Greatful

[lex1989]

36 minutes ago, Greatful said:

@lex1989 How long have you been using it.  What brand/manufacture? 

How much do you use and is it daily?

My son and his wife use it and gave me some last winter but I was to afraid of trying it.  He researched it and came up with a 2 brands  I know the one he uses comes out of Colorado and has lot numbers on it to connect to the fields that it was taken from.  Organic, 3rd party tested. 

Blue Bird botanicals I  think the name was

 

You are feeling pretty good after your cut, when was that.   

I use 1-2 times a week, just started last week, 5-8 ml, not more, the manufacturer specifies it should be taken 1ml / 10 kg corp.

I don't think you ever heard of it, it's from Europe, Lady Mary Farm is the brand name, one of the best providers here in Europe.

 

Why afraid of it, it's medicinal CBD, it is used in many therapeutic ways, with success, including epilepsy, anxiety, etc.

 

I have 1 week from my previous cut, I always feel good after 9-10 PM, no matter of using CBD oil or not, really strange ways.

[Altostrata]

7 hours ago, lex1989 said:

because I feel better at 4 mg , than at 5m, not much better, but better.

 

That's good. 

 

I have no idea if CBD oil is going to continue to work for you.

 

7 hours ago, lex1989 said:

Interesting approach , small problem here, my 2 x jewelry scales are not so accurate for me to do 0.1 mg decreases, I could do 0.2 mg tops.

 

People use liquid forms of the drug for this. Smaller reductions more frequently may be more tolerable. 

 

7 hours ago, lex1989 said:

0.5 mg cut on a 3 weeks basis

 

If you're taking 4mg, this is a speed of taper we would not recommend.  It's more than 10% every 3 weeks. You already made this mistake, bringing about an updose on October 22.

 

On 11/18/2021 at 3:34 PM, getofflex said:

....

I suggest taking this one step at a time, and being careful in your taper.  We want to make the taper faster, but I wouldn't do it by just reducing 0.5 mg for each taper.  I would suggest reducing by 10% of the current dose, but making a reduction more often, instead of every 4 weeks.  You may need to increase the clonazepam to deal with withdrawal syndrome.  Then, once you are off the escitalopram and stable, you can then taper of the clonazepam.  

....

 

[lex1989]

10 hours ago, Altostrata said:

People use liquid forms of the drug for this. Smaller reductions more frequently may be more tolerable. 

Okay, I understand, what do you think of 0.2 mg on every 8 days ? I'm really comfortable with the powder form , trying to keep it it possible.

 

10 hours ago, Altostrata said:

If you're taking 4mg, this is a speed of taper we would not recommend.  It's more than 10% every 3 weeks. You already made this mistake, bringing about an updose on October 22.

Yes, I agree, I did also 2 more big mistakes , brought a major stress in to my life exactly at the same time and changed from powder to solid while cutting at the same time. 😁

Maybe without these 2 I wouldn't had got those problems and I could stand it.

[lex1989]

I have found a good solution, will keep this post updated of how I am doing !

Will get the genesight result as well and will be back with info.

[lex1989]

On 11/19/2021 at 1:34 AM, getofflex said:

I know it doesn't seem right that it would take you a longer time to taper, than how long you were on the medication.  The problem is, even after 6.5 months, your brain is dependent upon this drug.  So in essence, you are caught between a rock and a hard place, because you are dependent on a drug that is causing you an adverse reaction, unfortunately.  Because of your adverse reaction, we do recommend an accelerated taper, so it should be faster than reducing by 10% of the current dose every 4-6 weeks.  It will be a balancing act. 

 

I suggest taking this one step at a time, and being careful in your taper.  We want to make the taper faster, but I wouldn't do it by just reducing 0.5 mg for each taper.  I would suggest reducing by 10% of the current dose, but making a reduction more often, instead of every 4 weeks.  You may need to increase the clonazepam to deal with withdrawal syndrome.  Then, once you are off the escitalopram and stable, you can then taper of the clonazepam.  

Can you please link the spreadsheet with your symptoms, so I can get a feel for how you have handled escitalopram reductions in the past?  Thank you.  

 

 

Sorry for the late response, I got lost in the message loops.

 

I am holding at the moment after my last cut to 4mg. It seems so anoying that I felt the cut after almost 2 weeks, the first days after the cut I was pretty good.

 

I am still trieing to figure what to do to handle the possible withdrawall that will come after the more accelerated tapper, to increase the Clonazepam again or to handle it with medicinal CBD.

[getofflex]

On 11/27/2021 at 5:10 AM, lex1989 said:

Okay, I understand, what do you think of 0.2 mg on every 8 days ? I'm really comfortable with the powder form , trying to keep it it possible.

If I were you, I would do what Altostrata suggested, and drop by 0.1 mg at a time.  She has helped thousands of people get off of psychiatric drugs, and knows what she is talking about.  It would be easy to do this with the liquid, which you can make yourself.   

 

Tips for Tapering Lexapro

Edited December 3, 2021 by getofflex

[lex1989]

13 hours ago, getofflex said:

If I were you, I would do what Altostrata suggested, and drop by 0.1 mg at a time.  She has helped thousands of people get off of psychiatric drugs, and knows what she is talking about.  It would be easy to do this with the liquid, which you can make yourself.   

 

Tips for Tapering Lexapro

Yeah I trust her completelly, there is not doubt, I actually found a good sollution with the powder, can scale 0.08 at a time, so I’l go with that atm and if I’l see if I need to switch to liquid or not.

 

I was talking about not beeing sure how to handle the possible withdrawall symptomps due to accelerated tapper, like mentioned above.

I really really don’t want to up the Clonazepam ( unless I have no other choice) as beeing another poison to taper than, I think you undestand me :). 

[getofflex]

1 hour ago, lex1989 said:

can scale 0.08 at a time, so I’l go with that atm and if I’l see if I need to switch to liquid or not.

This sounds good!  🙂

 

1 hour ago, lex1989 said:

I really really don’t want to up the Clonazepam ( unless I have no other choice) as beeing another poison to taper than, I think you undestand me :). 

Yes, I understand you.  We have a plethora of good techniques for coping with symptoms on this site you can use instead of relying upon clonazepam: 

 

Symptoms and Self Care

 

 

[lex1989]

1 hour ago, getofflex said:

This sounds good!  🙂

 

Yes, I understand you.  We have a plethora of good techniques for coping with symptoms on this site you can use instead of relying upon clonazepam: 

 

Symptoms and Self Care

 

 

 

Thank you, will read all the treads.

 

These couple of days I'm in the process of doing a change over to powder Clonazepam from solid, will do a slow / moderate change over. I've been told that our CNS is so sensitive in withdrawal that even a change over from solid drug to powder will be felt, is that true isn't it ?

 

[getofflex]

Yes do a crossover.  

 

Cross Over Changing from Tablet to Liquid

Edited December 4, 2021 by getofflex

[lex1989]

I am back with a possible important information. I did the genesight (genomind) test for psychiatric medicines, that Grateful mentioned.

 

Not very surprising, but here are the results :

 

As expected,  CYP2C19, the Gene / enzyme protein responsible for Escitalopram, has a Ultra-rapid metabolize on myself.

Risk of decreased serum levels. Possible adverse events associated with increased active metabolites. Alternative therapy should be considered.

 

I am no expert of this, but I read on different locations that this represent that Rapid and ultra-rapid metabolizers were demonstrated to have a decrease in the escitalopram levels of 13% and 36%, giving no benefits and increasing the risk different adverse effects, medicine should be avoided.

 

This patient is predicted to be a CYP2C19 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of escitalopram. Consider selecting an alternative SSRI not extensively metabolized by CYP2C19

 

Also, got this important results as well : 

Serotonin Transporter (SLC6A4) is a synaptic transporter protein responsible for
serotonin reuptake
􀂇 SSRIs act by blocking this transporter to produce a therapeutic response
􀂇 In Caucasians, greater risk of side effects, particularly gastrointestinal side
effects with SSRIs in S or L(G) allele carriers.

This demonstrating the adverse effects on the liver and also always having nausea, stomach acidity, gastroesophageal reflux (that somehow is triggering anxiety).

One more thing to add here is that the above statement is relevant for all SSRI's, all of them being exposed as the same risk.

There are just few SNRI's that would work, giving no possible side effects.

 

Now I know this test is not 100%, it's known about that, but there are clear evidence pointing in my real problems that I experienced with this medicine. 

 

 

 

Some other information that may be relevant or not :

 

MTHFR
C677T:
C/T
A1298C:
A/C
[Low to intermediate
activity]

Methylenetetrahydrofolate Reductase (MTHFR) is an enzyme responsible for the
conversion of folic acid to methylfolate, which is a cofactor needed for serotonin,
norepinephrine, and dopamine synthesis
􀂇 Risk for reduced MTHFR enzyme activity and reduced methylfolate
production
􀂇 L-methylfolate supplementation of SSRIs and SNRIs may result in greater
symptom reduction compared to SSRIs/SNRIs alone in major depressive
disorder
􀂇 L-methylfolate may be an effective monotherapy for patients with major
depressive disorder

 

 

ANK3
C/T
[Altered neuronal
signaling]

Sodium Channel (ANK3) is a protein that plays a role in sodium ion channel function
and is involved in excitatory signaling in the brain
􀂇 Abnormal sodium signaling may be clinically associated with conditions
characterized by mood instability or lability
􀂇 Several therapeutic agents are known to modulate sodium channel signaling

 

 

Here is the link for the complete result, if anyone is interested to see this kind of test (modified to protect personal intimacy, from page 2 everything it's in English): https://drive.google.com/file/d/1avgJBvZCqNZOVOr8fQ0VkwEgqAixEq1D/view?usp=sharing

 

 

 

 

 

[lex1989]

@getofflex

@Altostrata

 

If you have time to check the above post, it anything is relevant of course.

[getofflex]

I looked at it, but it is over my head.  I'm not a medical professional.  

Edited December 14, 2021 by getofflex

[ChessieCat]

  

7 hours ago, lex1989 said:

 

Question ? I've been wondering about if there is a topic on the forum related to immediate bad reactions to an AD ?

 

Related to the fact that if someone feels much more sick after starting on an AD and should be taken off that AD, not trying to push through, like doctors thing it's "normal" to have that reaction.

 

 

@lex1989

 

I will respond to your PM question here in your Introduction topic.

 

But I only took it for a Week

 

immediate-adverse-reactions-to-an-antidepressant-or-within-a-few-doses-how-long-for-recovery

 

 

[Altostrata]

On 12/11/2021 at 9:10 AM, lex1989 said:

There are just few SNRI's that would work, giving no possible side effects.

 

Hello, you have misunderstood the scope of this test, which is understandable because it is very much hyped, to sell to doctors and patients to make a profit.

 

What the test shows is that your liver may handle certain drugs certain ways. It does not show what would "work" -- presumably, that means working the miracle of eliminating "depression" or whatever. It merely indicates the drugs that at *less likely* to cause adverse effects via liver metabolism. They still may cause adverse effects via other avenues, however, and they may not "work" miracles.

Edited January 8, 2022 by manymoretodays
none, doing a share

[lex1989]

12 hours ago, Altostrata said:

 

Hello, you have misunderstood the scope of this test, which is understandable because it is very much hyped, to sell to doctors and patients to make a profit.

 

What the test shows is that your liver may handle certain drugs certain ways. It does not show what would "work" -- presumably, that means working the miracle of eliminating "depression" or whatever. It merely indicates the drugs that at *less likely* to cause adverse effects via liver metabolism. They still may cause adverse effects via other avenues, however, and they may not "work" miracles.

 

Understood, makes sense, as this is pointed out to sell like any other drug... In any situation it still gave me some insight of the adverse reaction from Lexapro.

 

@ChessieCat Thanks for the links.

 

I found myself clearly here : 

 

 

On 3/17/2013 at 7:34 PM, Altostrata said:

ADMIN NOTE We have a group of people here who have had a fairly immediate severe adverse reaction to SSRIs, often within a few doses (see "immediate adr" tags). These are people who are so sensitive to drugs, usually antidepressants, they have a severe adverse drug reaction (ADR) to drug after one dose or only a few. This also occurs after single doses of LSD or MDMA (also serotonergics).

 

They experience the drug effect as too strong, with symptoms of activation and perhaps desperate and violent thoughts -- the drugs are simply not suited to their neurologies or metabolism. This is because of variability in individual reaction to drugs. It is not a psychiatric or neurological disorder.

 

Though these people don't take the drug long enough to be at risk for withdrawal, they have symptoms identical to withdrawal symptoms after they cease the drug.

 

On 7/5/2020 at 10:42 PM, brassmonkey said:

 

I think that some of the most unfortunate members we have are the ones who only took the drug for a short time and had a severe Adverse Reaction. Over the years I’ve seen a number of members join who have taken their drugs for one day to a week and then stopped.  They suffer acute symptoms that hit immediately and hard.  Some people’s chemical makeup just isn’t compatible with psych drugs and their body immediately tries to reject them, but in doing so throws itself into chaos.

 

The good news is that their body will sort itself out and they will return to normal.  While this is recovery from a severe adverse reaction and not withdrawal syndrome, the bad news is the post-discontinuation symptoms are a lot like post- acute withdrawal syndrome (PAWS), and it’s going to take a long time and there is nothing that will speed up the process.  There are some coping strategies and tools that will help you endure the experience, but time is the only thing that will cure it, and it will take months rather than weeks.

 

These people tend to have a more linear recovery than those with true withdrawal syndrome. The first several months may be more intense.  Then, like PAWS, things start to improve very slowly. Eventually, normal life resumes and get back on track.  All the members I have known with this immediate Adverse Reaction have made full recoveries and gone on to normal lives and careers.

 

Although the difference is that I took it long enough to become also dependent on it besides the adverse reaction to it. Great...

The only "good" situation on it it's that it's the only drug, besides Clonazepam that I every took in my life for a couple of months, that's it and also the fact that I am young, I really hope this will help to a better recovery.

 

I also found myself in this situation :

 

 

On 11/23/2013 at 10:23 PM, Altostrata said:

People who have immediate adverse reactions to serotonergics often have severe symptoms for quite a while -- symptoms very much like withdrawal syndrome -- and take a long time to recover.

 

If they've been kept on the drugs for a long time, often with the aid of a benzo, their nervous systems are quite distressed.

 

The first few days on Lexapro, on just 2.5 mg, where brutal, than the increase in Clonazepam was needed to "help" with the "normal side effects" that the kind doctor was presuming it's normal when you first take it.

 

Then it does make real sense, every time I tried to lower the dosage of the benzo, anxiety kicked in, wonder why ?

I am not saying that it could be possible that I got benzo withdrawal as well, as the benzo seem to not cover any more side effects at the same dosage after ~3-4 months (0.5 mg Clonazepam) and anxiety kicked in again, also after I got a fast taper from 0.5 to 0.3 mg all hell broke loose, to few benzo to mask the side effects and also some withdrawal from the benzo as well.

 

 

So now I find myself in withdrawal from both the medicines, in this situations and a bonus from the adverse effects from Lexapro. Not mentioning the liver damage. Yay, thank you Big Pharma and psychiatric industry, you make my life wonderfull.

[Altostrata]

11 hours ago, lex1989 said:

Then it does make real sense, every time I tried to lower the dosage of the benzo, anxiety kicked in, wonder why ?

 

The benzo may have masked the effects of Lexapro, or you may be getting rebound or breakthrough withdrawal from the benzo, or this might be benzo withdrawal symptoms.

 

Please stop changing your drug, in order to identify a baseline symptom pattern. Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. 

[lex1989]

12 hours ago, Altostrata said:

 

The benzo may have masked the effects of Lexapro, or you may be getting rebound or breakthrough withdrawal from the benzo, or this might be benzo withdrawal symptoms.

 

Please stop changing your drug, in order to identify a baseline symptom pattern. Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. 

 

I did not change anything. I spoked here from the past, when my psychiatrist made my dose changes, in the first 2 months. 

[lex1989]

What do you mean rebound or breakthrough withdrawal ?

On 12/22/2021 at 1:49 AM, Altostrata said:

 

The benzo may have masked the effects of Lexapro, or you may be getting rebound or breakthrough withdrawal from the benzo, or this might be benzo withdrawal symptoms.

By the way, tomorrow I will start the 0.1 mg each 4 days Lexapro tapper

[getofflex]

Sounds good.  Let us know how it goes. 

[lex1989]

@Frogie This post it's mostly addressed to you, as you have good knowledge in benzo wise situations.

So first of all I need to explain the whole situation with a resume, because it will definitely will help, sorry for the following long post.

 

I've been prescribed Escitalopram and Clonazepam for anxiety disorder. There is to noted that before the medicine I had good days also (almost 90-95%), while having bad days as well (50-70%), it fluctuated, this is important. Because now I am like 30-40% tops overall so yeah...

I had anxiety disorder just for ~ 2 weeks , prior having just 1 panic attack or anxiety attack / month because of staying in chronic stress at work a couple of months / burn-out.

I had then a bad panic attack that triggered my anxiety disorder.

The bad decision was to go to psychiatric medicine for that, while things should have become better in time with CBT and some supplements, but I was afraid as this did not happen to me before and did not understood it (just a period 17 years ago when I was a kid I had some panics attacks in sleep for a couple of months that disappeared), made the wrong decision, I know that for sure now.

 

Now the actual question goes to understanding my current schedule of the symptoms : I am always better after 9-10 PM, while at 00 I am almost 100%. I want to understand this, why is it like this, many other people in withdrawal have fluctuating waves and windows during the day, but for me it's like fixed all day (95% of the time).

I know that there are 3 possible situations : 

1) Inter-dose withdrawal from benzo, I take at 23 PM. 0.3 mg Clonazepam

2) Adverse reaction from A/D, while taking it at 13:00 (in the past I took it at 23 at the same time with benzo and seem to have the same schedule of symptoms)

3) Due to the cortisol from circadian rhythm, I have read in many forums (including benzo buddies), people with similar symptom schedule, being better at noon. Basically the cortisol that is higher trough the day, while at 00 it almost disappears, while in withdrawal people feel it much harder on themselves.

 

Now a small resume of how the doctors have been switching my dosages around, this is relevant as well :

 

1) I started with 2.5 mg (quarter) of Escitalopram and 0.375 (3/4 pill) Clonazepam. The adverse reaction from Escitalopram was so intense I communicated the doctor I could not bear this big increase in symptoms, but she just said it's "normal" until the body adapts, little I knew back then that it's not normal. 

Then of course it raised the Clonazepam, at around 0.650 but also raised the Escitalopram at 5mg. In 2 weeks the body somehow accepted better the Escitalopram or basically the Clonazepam just masked the adverse reaction. My anxiety got much better, was around 90%.

 

2) At some point I needed to lower the benzo, as I was told it gives dependency (reminder that I did not knew much about then), so I went from 0.650 to 0.5 with no problems, then I went from 0.5 to 0.375 again with no problems (the cut was made almost instant, no taper), this being in the first month. I was taking 0.25 before sleep and 0.125 in the morning.

The problems started to occur after going from 0.375 to 0.25, anxiety kicked in again, but a bit different.

 

3) After the monthly visit to the doctor, I said anxiety kicked in after I reduced  it to 0.25. She said to increase again the benzo to 0.375 and stay 2 more weeks like adding 2.5mg to the Escitalopram (7.5 mg total), afterwards reduce the benzo again to 0.25 and raise the Escitalopram to 10 mg.

 

4) At the ending of the second month when I started to raise the Escitalopram to 10 mg and reduce the Clonazepam to 0.25 (fast taper advised by doc, 1 day 0.375, 1 day 0.25 in 1-2 weeks time) all hell broke loose slowly. My sleep has been awful starting that point till today (can sleep but with a lot of disturbances), anxiety, etc.

 

5) As as seen things started to become more worse than before took the medicine I changed the doc, the second one said I don't need 10 mg of Escitalopram (because maybe it's causing me anxiety at that dose, but hey, if she said that why keep me still on it)so take 5 mg, instant cut, no taper. And raise the Clonazepam to 0.5 mg. She also added them at the same time before sleep.

I stood on this program for about ~ 3 more months, with no fantastic results. Than things started to be even more bad.

 

6) I started to question, finally, the psychiatric doctors decisions and knowledge and I needed to become "my own expert" in this.

I started to read everything that I could about this drugs (benzo buddies, SA, etc).

 

7) I found that it's a big change that I am already in tolerance with the benzo (4-5 months on almost same dosage) and started to get withdrawal symptoms because of that and also taught about that the benzo can no longer mask the adverse effects from the Escitalopram. That being said, I am both in withdrawal from benzo and in adverse effect from A/D.

That is why I could not be very stable in the first place I decided to taper and get rid of this medicine.

 

 

So what do you thing @Frogie ?

All being said above, being always better after 9-10 PM (sometimes even faster) and v good at 00, is this related to the inter dose withdrawal from the benzo (taking 0.3 mg at the moment at 23), adverse effect from the A/D taken at 13 (took it at night before sleep in the past and the symptoms during the day seem to be kind of the same) or related to the decrease in cortisol at noon / night.

Also, do you think it would help to move half of the 0.3 mg of Clonazepam in the day, to help with the inter dose withdrawal ? To be noted that I don't feel anymore relief when taken, as I got into de dependency. I even tried to move it couple of times at 1-2 AM just to test the theory if I feel better without the benzo and it was true, I did (going more for the cortisol in withdrawal thing here).

 

Sorry for the long post. This is mostly my curiosity and probably will help to understand this and maybe do something with the inter dose withdrawal if it's the case.

 

Note : I am tapering Escitalopram now (3.84 mg current), 0.1 / 0.08 mg each 4 day as Alto advised (I have a liver reaction from the Escitalopram and need to taper a little faster).

 

Thank you !

 

 

[Frogie]

On 1/4/2022 at 10:01 AM, lex1989 said:

I had then a bad panic attack that triggered my anxiety disorder.

The bad decision was to go to psychiatric medicine for that, while things should have become better in time with CBT and some supplements, but I was afraid as this did not happen to me before and did not understood it (just a period 17 years ago when I was a kid I had some panics attacks in sleep for a couple of months that disappeared), made the wrong decision, I know that for sure now.

No, you didn't make a bad choice or decision. You reached out for help and unfortunately drs and/or psychiatrists only know to "throw" these medications at us to mask the symptoms that eventually would go away with more therapy. But that is just my opinion. I had a great therapist that knew all about 10% tapering and didn't believe in psychiatrists throwing meds at you. So she was a huge help in my taper along with this site. Don't blame yourself at all.

 

On 1/4/2022 at 10:01 AM, lex1989 said:

I found that it's a big change that I am already in tolerance with the benzo (4-5 months on almost same dosage) and started to get withdrawal symptoms because of that and also taught about that the benzo can no longer mask the adverse effects from the Escitalopram. That being said, I am both in withdrawal from benzo and in adverse effect from A/D.

That is why I could not be very stable in the first place I decided to taper and get rid of this medicine.

I'm not going to quote each of your situations. I can't believe you have been in and out, up and down as much as you have and don't have any worse symptoms that you so. Your body is really handling it well for what you have gone/are going though. But I really think at this point you are going through interdose withdrawal.

 

There is a pretty good article on interdose withdrawal here on SA. It does talk about splitting your doses and you may want to consider splittling the Clonazepam  into 2 doses and see if that might help. Just make sure you take it at least an hour before the Lexapro.

 

 

If this doesn't help or bring you any relief at all my next step would be tapering you off the Clonazepam. I just don't like to mess with a benzo when you are tapering off of Lexapro because it does help with they side effects of the Lexapro. I wouldn't change my dose of Lexapro until you see how this dose splitting affects you for just a few days.

 

Keep me posted. 

[lex1989]

First of all thank you for the reply @Frogie !

 

16 hours ago, Frogie said:

No, you didn't make a bad choice or decision. You reached out for help and unfortunately drs and/or psychiatrists only know to "throw" these medications at us to mask the symptoms that eventually would go away with more therapy. But that is just my opinion. I had a great therapist that knew all about 10% tapering and didn't believe in psychiatrists throwing meds at you. So she was a huge help in my taper along with this site. Don't blame yourself at all.

 

Yes, that is what 99% of the psychiatrists know, to prescribe you pills, that have a pretty high chance of making it far worse, if not immediately, then in the long term. I am still astonished by people that clam they have seen these drugs as life changers for them.

I know some people in real life that claim that, but know also people that have been damaged greatly by this drugs, from my personal point of view the risks are far worse than the possible benefits.

 

 

16 hours ago, Frogie said:

I'm not going to quote each of your situations. I can't believe you have been in and out, up and down as much as you have and don't have any worse symptoms that you so. Your body is really handling it well for what you have gone/are going though. But I really think at this point you are going through interdose withdrawal.

 

Don't get me wrong, I am not doing great, as I mentioned, I am like ~40%, maybe. Just holding on and accepting in the hell I am so I won't put any more stress on top of it to get in a downward spiral, sometimes I break, but happens rarely. I know I can do this! After I get the post-acute period things will be much better, I am hopeful. 

 

16 hours ago, Frogie said:

There is a pretty good article on interdose withdrawal here on SA. It does talk about splitting your doses and you may want to consider splittling the Clonazepam  into 2 doses and see if that might help. Just make sure you take it at least an hour before the Lexapro.

 

 

Yes, good article, I've read it. 

There are few things to be clarified with your help, before I split my dose :

Note : I've done the gene sight test and have important information about the enzymes my body metabolizes related to the psychiatrics drugs.

 

1) Clonazepam half life time is about 18-50 hours (Ashton manual and other sources), while here I am a normal metabolizer. I know for sure Clonazepam it worked for me, when it was necessary and of course before I had tolerance with it.

 

2) Escitalopram half life time is 24-30 hours (Wikipedia), here I am an ultra-rapid metabolizer (CYP2C19 gene). Is this relevant ? Maybe somehow we have here inter-dose withdrawal? The only sure thing I know is that it seemed never good to me and I have adverse-reaction from it.

 

3) I've made a mistake 3 days ago and at 23 I took Escitalopram pill instead of Clonazepam, then I realized and took the Clonazepam as well. But as doing this mistake I did not want to take Escitalopram the following day again at 13, I am not sure if I should have or not, never happened before.

But doing this mistake I had a different kind of symptom schedule: the next day without Escitalopram was much better in the first part of the day, while in the second part, including noon and night was worse (it seemed like a CT for those couple of hours), maybe this is relevant.

I need I think a couple of days to stabilize after this mistake, as it seems it gotten be dr and dp very fast while doing this dosage skip, while usually I don't have dr and dp.

 

4) I've done a test, related to my daily symptoms, as I was in holiday in the past 3 weeks, I have put myself much later to sleep (not a good idea overall I know). I did this to test the theory of cortisol elevations which fluctuate throughout the day.

While I am generally better after 9-10 PM (when I have a normal sleep schedule) and at 00 I am almost 100%, after I started to put myself to sleep in the holiday at 4-5 AM and sleeping until ~13 PM, I noticed in the first days that it worked, meaning that normal cycle was the same, while being almost 100% from 00 to 4-5 AM until I got to sleep.

But after a few more days, it seemed my circadian rhythm has shifted, meaning that I no longer was better after 9-10 PM, but after 00 and being almost 100% after 3-4 AM. I guess shifting your circadian rhythm can be a real thing.

I am now slowly getting back to my normal schedule. I am not sure this is 100% relevant, but wanted to share with you, as I have a almost clear pattern in my daily symptoms, not so random like others do in withdrawal.

 

5) Also to be considered the fact that I get better before actually getting the Clonazepam dose at 23, so it seems has nothing to do with it, does it ? If it's inter-dose withdrawal, shouldn't this happen immediately after I take the benzo dosage (or after the effect time of the benzo, ~1  hour for Clonazepam)?

 

6) During the mid-day, if I try to sleep, for whatever reason, I cannot, basically as I fall asleep I get up right away with a feeling o dread / fear with some heartburn as well. Did not had this problems before the drugs, of course. But at night I can fall asleep easily.

I don't know if it's relevant, just pointing it out.

 

If you have time and want to check my gene sight test : https://drive.google.com/file/d/1avgJBvZCqNZOVOr8fQ0VkwEgqAixEq1D/view?usp=sharing

I know it can be relative, but it does point for some important stuff.

 

Based on the following, I will wait for your response and take a decision regarding the dose splitting.

 

[Frogie]

Hi @lex1989

 

I don't know much about the gene stuff, unfortunately. I do know another moderator that has a lot of experience with this stuff. Would you mind if I asked them to help me out?

[lex1989]

Sure @Frogie

[Frogie]

@DataGuy

 

Do you think you could take a look at @lex1989 last couple of posts and help her out? I just don't understand the "gene" stuff and I know you have experience in it.

 

Thanks for the help. I really appreciate it!

[DataGuy]

Hi @Frogieand @lex1989,

 

Just read things over a bit. Yes, looks like you are an ultrarapid metabolizer at one enzyme and a poor metabolizer at another that metabolizes escitalopram, @lex1989. Seems like from your description of your experience that the ultrarapid enzyme outweighs the reduced activity at the "poor" one, so it may be a good idea to split up your dose and see if that improves things for you. Following the instructions in Chessiecat's post is probably your best bet for a smooth transition. Here is an article on the enzymes which metabolize escitalopram, if you are interested: https://pubmed.ncbi.nlm.nih.gov/17375980/

 

The fact that you feel better before the clonazepam dosage may simply just be your body settling down for the night. Generally your body temperature and blood pressure lower at night and this could simply be lowering the intensity of your wd symptoms. When your circadian rhythm shifted from changing your bedtime, it likely shifted the times at which your body relaxes for sleep. 

 

And yes, sometimes these drugs will prevent people from being able to nap. I couldn't nap while I was on them for 15 years, but I can now that I am off. 

 

Hope the dose-splitting helps @lex1989 : )

[Frogie]

@DataGuy

 

Thank you sooo much for the help! 

[DataGuy]

No problem, @Frogie : )

[lex1989]

1 hour ago, DataGuy said:

Hi @Frogieand @lex1989,

 

Just read things over a bit. Yes, looks like you are an ultrarapid metabolizer at one enzyme and a poor metabolizer at another that metabolizes escitalopram, @lex1989. Seems like from your description of your experience that the ultrarapid enzyme outweighs the reduced activity at the "poor" one, so it may be a good idea to split up your dose and see if that improves things for you. Following the instructions in Chessiecat's post is probably your best bet for a smooth transition. Here is an article on the enzymes which metabolize escitalopram, if you are interested: https://pubmed.ncbi.nlm.nih.gov/17375980/

 

The fact that you feel better before the clonazepam dosage may simply just be your body settling down for the night. Generally your body temperature and blood pressure lower at night and this could simply be lowering the intensity of your wd symptoms. When your circadian rhythm shifted from changing your bedtime, it likely shifted the times at which your body relaxes for sleep. 

 

And yes, sometimes these drugs will prevent people from being able to nap. I couldn't nap while I was on them for 15 years, but I can now that I am off. 

 

Hope the dose-splitting helps @lex1989 : )

 

Fantastic post and response @DataGuy,

 

I agree with everything you said and you basically saw the same thing that I was thinking.

I knew there is something to do with the cortisol fluctuation throughout the day. The fact that you "the body is settling down for the night" and the blood pressure is lower, I am thinking now, maybe it's a stupid idea, a medicine or a supplement that lowers blood pressure during the day, would help to lessen the withdrawal symptoms as well ? If you think about it it makes sense, but Idk, just asking, would be awesome to have time to time a relief during the day as well lol. 

 

I know the link : https://pubmed.ncbi.nlm.nih.gov/17375980/. I've been documenting myself like a true becoming expert lol :D.

The CYP2C19 being the ultra fast one indeed and also predominant as far as I know in many medicines and also in the case of Lexapro, probably overcompensates the lazy one CYP2D6 , while being normal metabolizer for CYP3A4.

 

I also tried some CBD oil during last weeks, it has 2 out of 3 enzymes the same as Lexapro (and also potential adverse effects with it because of that). And the first 2 times I took it it was wonderful, it lessen almost all my withdrawal symptoms, but on the 3rd and 4th time didn't worked to well. Maybe the enzymes interfered or being metabolized ultra fast as well for CBD.

 

Now related to the most important topic : How should I split and what ? I guess we are talking about the Lexapro and not the Clonazepam as me and @Frogie thought it should be split for the inter-dose withdrawal.

Following the Chessiecat's post, shall I split the Lexapro in the following sequence ? :

Day 0 : Lexapro 3.74 mg (current) at 13:00

Day 0 : Lexapro 3.74 mg (current) at 13:00

Day 0 : Lexapro 3.74 mg (current) at 13:00

Day 0 : Lexapro 3.74 mg (current) at 13:00

 

[lex1989]

1 hour ago, DataGuy said:

Hi @Frogieand @lex1989,

 

Just read things over a bit. Yes, looks like you are an ultrarapid metabolizer at one enzyme and a poor metabolizer at another that metabolizes escitalopram, @lex1989. Seems like from your description of your experience that the ultrarapid enzyme outweighs the reduced activity at the "poor" one, so it may be a good idea to split up your dose and see if that improves things for you. Following the instructions in Chessiecat's post is probably your best bet for a smooth transition. Here is an article on the enzymes which metabolize escitalopram, if you are interested: https://pubmed.ncbi.nlm.nih.gov/17375980/

 

The fact that you feel better before the clonazepam dosage may simply just be your body settling down for the night. Generally your body temperature and blood pressure lower at night and this could simply be lowering the intensity of your wd symptoms. When your circadian rhythm shifted from changing your bedtime, it likely shifted the times at which your body relaxes for sleep. 

 

And yes, sometimes these drugs will prevent people from being able to nap. I couldn't nap while I was on them for 15 years, but I can now that I am off. 

 

Hope the dose-splitting helps @lex1989 : )

 

Fantastic post and response @DataGuy,

 

I agree with everything you said and you basically saw the same thing that I was thinking.

I knew there is something to do with the cortisol fluctuation throughout the day. The fact that you "the body is settling down for the night" and the blood pressure is lower, I am thinking now, maybe it's a stupid idea, a medicine or a supplement that lowers blood pressure during the day, would help to lessen the withdrawal symptoms as well ? If you think about it it makes sense, but Idk, just asking, would be awesome to have time to time a relief during the day as well lol. 

 

I know the link : https://pubmed.ncbi.nlm.nih.gov/17375980/. I've been documenting myself like a true becoming expert lol :D.

The CYP2C19 being the ultra fast one indeed and also predominant as far as I know in many medicines and also in the case of Lexapro, probably overcompensates the lazy one CYP2D6 , while being normal metabolizer for CYP3A4.

 

I also tried some CBD oil during last weeks, it has 2 out of 3 enzymes the same as Lexapro (and also potential adverse effects with it because of that). And the first 2 times I took it it was wonderful, it lessen almost all my withdrawal symptoms, but on the 3rd and 4th time didn't worked to well. Maybe the enzymes interfered or being metabolized ultra fast as well for CBD.

 

Now related to the most important topic : How should I split and what ? I guess we are talking about the Lexapro and not the Clonazepam as me and @Frogie thought it should be split for the inter-dose withdrawal.

Following the Chessiecat's post, shall I split the Lexapro in the following sequence (would go for 2 hours instead of 1 hour each day, what do you think ) ? :

Day 0 : Lexapro 3.74 mg (current) 13:00 Clonazepam 0.3mg 00

Day 1 : Lexapro 1.87 13:00 Lexapro 1.87 15:00 Clonazepam 03.mg 00

Day 2 : Lexapro 1.87 13:00 Lexapro 1.87 17:00 Clonazepam 03 mg 00

Day 3 : Lexapro 1.87 13:00 Lexapro 1.87 19:00 Clonazepam 0.3 mg 00

Day 4 : Lexapro 1.87 13:00 Lexapro 1.87 21:00 Clonazepam 0.3 mg 00

Day 5 : Lexapro 1.87 13:00 Lexapro 1.87 23:00 Clonazepam 0.3 mg 00

 

What do you think ?

Should I split the Clonazepam as well, does it makes sense, maybe it's inter-dose there as well as Clonazepam half-time it's 18-50 hours.

 

@Frogie Thank you so much for the support. 

2 hours ago, Frogie said:

@DataGuy

 

Do you think you could take a look at @lex1989 last couple of posts and help her out? I just don't understand the "gene"

I'm a he, hahaha, cheers >:D< 🥰

 

[Frogie]

@lex1989

 

Here is a link that explains splitting doses. Read this and we can go from there🙂