essenceofllama: intro - trying to find a balance

[essenceofllama]

I suffered with undiagnosed/untreated Postpartum Depression for over a year after my first child was born. I was able to get it mostly under control with therapy, until the 3rd trimester of my second pregnancy, when the symptoms resurged and continually worsened as I approached my due date. After much research and many discussions with my therapist/OB, I finally decided to start 5mg Lexapro at 34 weeks in December 2020. Lexapro and Zoloft were my only options because I was pregnant.

 

This was my first introduction to antidepressants, and it was incredible; it helped me so much. It pulled me out of the darkness and despair of PPD, allowed me to be fully present with my family, and helped me weather all the sleepless nights that come with having a newborn. Then, around July 2021, 6 months postpartum, I started feeling like my PPD symptoms had been slowly creeping back, so we changed my dose to 10mg. It seemed to help for a while, but after 3 months, I felt the PPD symptoms returning again. We changed my dose to 20mg in October 2021.

 

Six weeks later, the weekend of 11/13 and 11/14/2021. I started realizing I was having intense side effects: agitation, confusion, restless legs if I sat or laid down for more than 2 minutes, rocking, hand wringing, inability to think logically from point A to point B, obsessive behaviors. I decided I needed to reduce my dose, so based on a Reddit post I saw, I was going to do a week at 17.5mg, then a week at 15mg, then a week at 12.5mg, before going down to 10mg. My reasoning was that since I wasn't going off completely, I could do a relatively quick taper.

 

I spoke to my prescribing doctor on 11/15, and she agreed we should reduce the dose, but did not think I needed to taper because I’d only been on 20mg for 6 weeks and I wasn’t going completely off the drug. We also decided that since 10mg Lexapro wasn’t fully controlling my symptoms, we would add 150mg Wellbutrin XL. I decided to do an even shorter taper after our discussion and just did 1 day each of 17.5mg, 15mg, 12.5mg, and finally 10mg on 11/18.

 

I took my first dose of Wellbutrin at bedtime on 11/16, and I slept better than I have in years. Also, my chronic pain was incredibly low on 11/17 - I could move almost like a normal person! I was so hopeful and excited for the future. Then on 11/19 I was officially told my chronic pain/chronic illness diagnosis - non-radiographic axial spondyloarthritis, so I started sulfasalazine on 11/20. That day I felt emotionally unstable, cried frequently, had severe depression, and had some loss of appetite, nausea, and diarrhea. I thought I was having side effects from the sulfasalazine so I discontinued it.

 

I felt mostly normal on 11/21 and most of the day on 11/22. Then at 6pm on 11/22, I started having nausea and depression symptoms. And it just kept getting worse until I vomited at 8:30p and 10:30p. I couldn’t get out of bed but I couldn’t sleep. My list of symptoms started rapidly increasing: nausea, vomiting, loss of appetite, diarrhea, muscle cramps, sensitivity to light and sound, tinnitus, depression, crying, fatigue, dizziness, insomnia, confusion.

 

I decided to take 15mg of Lexapro on 11/23 to see if it would help my symptoms. I don’t know why; I just thought it was the right thing to try. Slowly, over the next 5 hours, my symptoms started to lessen in intensity. I was able to go feed the baby and go to a doctor’s appointment, but I could still barely eat. At the doctor’s office I saw a PA because my doc was out of town for the thanksgiving holiday, and he seemed confused by my assessment that I was having SSRI withdrawals, almost as though he’d never heard of it, though he seemed to have experience with antidepressants.

 

Regardless, he was supportive and called in 60 tablets of 10mg Lexapro to help me do a bit of a taper. His recommendation was to stay at 15mg until the Wellbutrin is at full effectiveness (~3 weeks from now), and then drop to 10mg. I don’t think I’ll be doing that. I also got an appointment with a psychiatrist for 1/12/2022. I’m hoping I can get some liquid prescribed by her to help me taper down to 10mg more slowly. Last night (11/23) I finally was able to get a mostly good night of rest, and I actually felt sort of hungry this morning (11/24). I was able to get out of bed and feed the baby on my own. I have hope that I’ll be able to get through this.

 

My questions right now are: Am I on the right path? Did I catch the withdrawal symptoms and increase my dose early enough to hopefully avoid most of the long term withdrawal side effects? About how long should I hold at 15mg before trying to taper down again? I do think I’m having some of the high dose side effects (like restless legs) again at 15mg, so I don’t think it’s sustainable long term, but I can probably hold out until my psych appointment in January.

 

I’m so grateful I found this community. Any advice or experience you can share with me would help me so much.

Edited November 25, 2021 by Kiasofia
Added paragraphs and changed font.

[manymoretodays]

Hi there essenceofllama and welcome aboard,

On 11/24/2021 at 7:40 AM, essenceofllama said:

Six weeks later, the weekend of 11/13 and 11/14/2021. I started realizing I was having intense side effects: agitation, confusion, restless legs if I sat or laid down for more than 2 minutes, rocking, hand wringing, inability to think logically from point A to point B, obsessive behaviors. I decided I needed to reduce my dose, so based on a Reddit post I saw, I was going to do a week at 17.5mg, then a week at 15mg, then a week at 12.5mg, before going down to 10mg. My reasoning was that since I wasn't going off completely, I could do a relatively quick taper.

 

 

 

 

When did you start to feel relief of these symptoms after you decreased the Lexapro?

 

Then I am seeing some ? relief after starting Wellbutrin, then changing symptoms, and a large updose in Lexapro.

 

What we need to see on, or shortly after registration, is a Signature:

How to summarize your drug history in your signature

take a look at the link ^, and then follow the instructions to do your own Signature.  Note-this is different than the confidential information you provided on registration,  and once done will appear below all your posts.  It does give us a nice quick summary to refer to, whenever and wherever you post on site.

 

I'm not certain that you are on the right path just yet, I don't know why anyone would prescribe 2 AD's(antidepressants) for anyone.  Yours are each a bit different in drug make-up......but still.

And it's never a great idea to be doing a whole lot of self adjustment to medications, before empowering oneself with information and education.

Are you looking to eventually taper or maintain on the lowest possible dose of your drug?  I am hoping so.

 

Another thing that you could do now, for us, and for yourself is to begin to get familiar with your drugs:

I use Drugs.com

You can plug in your drugs individually, as well as check for drug interactions there too.

You'll begin to see some of the myriad of side effects/adverse effects from some of these psychoactives, and then when given any new prescriptions, can begin to perhaps get the full information on any drug before you agree to ingest it.

You might go ahead and check your present drug interactions now there, and then share those results with us, with a link, or copy and paste.

 

On 11/24/2021 at 7:40 AM, essenceofllama said:

My questions right now are: Am I on the right path? Did I catch the withdrawal symptoms and increase my dose early enough to hopefully avoid most of the long term withdrawal side effects? About how long should I hold at 15mg before trying to taper down again? I do think I’m having some of the high dose side effects (like restless legs) again at 15mg, so I don’t think it’s sustainable long term, but I can probably hold out until my psych appointment in January.

 

That's one hefty dose of Lexapro there too, that 15 mg dose.  I think you are referring to the Lexapro.

Often when we talk about reinstatement, or updosing, we've found that it is much more harm reduction, to do so at minimal doses, oftentimes, just a 0.5 or 1 mg dose.

 

I'll leave you with a couple of basic links today, and we'll look forward to your return and seeing your signature and further reports/updates.

 

Why taper by 10% of my dosage?

This ^ is our harm reduction method of beginning a taper 

Tips for tapering off Lexapro

 

What is withdrawal syndrome.

The windows and waves pattern of withdrawal

 

Dr.Glenmullen’s withdrawal symptom list.

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, communicate with staff and other members,  and keep a record of your journey here too.

 

How are  you doing today?

 

Welcome again,

Love, peace, healing, and growth,

moderator manymoretodays

 

 

 

Edited November 26, 2021 by manymoretodays
links, informational

[Altostrata]

Welcome, @essenceofllama

 

Yes, it sounds like you got withdrawal symptoms from reducing Lexapro and you did reinstate part of the amount you had decreased, which is an accepted practice to address withdrawal symptoms from too-fast tapering. You were lucky you saw the right Reddit post!

 

It also sounds like you might have had an adverse drug-drug interaction from adding sulfasalazine to escitalopram and bupropion. If I were you, I'd make a habit of using a Drug Interactions Checker before adding any drug, even over-the-counter. 

 

If you put escitalopram and bupropion into the Drug Interactions Checker, you will see they do have a potential dangerous drug interaction -- even though they are often prescribed together.

 

On 11/24/2021 at 6:40 AM, essenceofllama said:

Then, around July 2021, 6 months postpartum, I started feeling like my PPD symptoms had been slowly creeping back, so we changed my dose to 10mg. It seemed to help for a while, but after 3 months, I felt the PPD symptoms returning again. We changed my dose to 20mg in October 2021.

 

There is a simple and predictable reason for why this happened: Over time, your nervous system adapts to a psychiatric drug, and it loses whatever beneficial effect it had. Colloquially, this is called "poop-out". Your honeymoon with escitalopram is over -- you cannot tolerate higher dosages, which what doctors always try.

 

It's also typical that doctors combat "poop-out" by adding drugs. If bupropion poops out, it will be another drug. Because these drugs are so hard to quit, you are on your way to a life-long drug spiral.

 

It's good your doctor is cooperating in your intention to taper escitalopram. If I were you, I'd plan to decrease the dosage to zero. It's not doing much anymore except interacting with bupropion.

 

Read this carefully Tips for tapering off Lexapro

 

Also, if I were you, I'd explore the components of your PPD with a therapist, see if you can address those symptoms with durable non-drug means with an intention to eventually go off bupropion, or it's very likely you'll be a menopausal granny taking a batch of psychiatric drugs for long-ago PPD. We have a number of members here in that situation.

[essenceofllama]

@Altostrata - Thank you for the welcome and your reply. It is comforting to know that I was somehow able to do something right (reinstating part of the amount I decreased) even though I literally felt like I was dying. I am starting to see improvements: I have slept well 2 of the last 3 nights, I'm able to eat again, my nausea is decreasing in frequency and intensity, and my mood is stabilizing. Tomorrow is Day 5 of 15mg.

 

I will definitely read the Tips for tapering off Lexapro. I hadn't started putting together a long-term plan yet, but I think this is where I'm heading:

1. Survive these withdrawals
2. Stabilize on 15mg Lexapro (not sure how long I need to do this... 2 weeks? 6 weeks? more? I'd like it to be as short as possible because 15mg is still way too high for me - I do not like it.)
3. SLOWLY taper down to 10mg, maybe stop to stabilize here for some period of time?
4. SLOWLY taper down to 5mg, maybe stop to stabilize here for some period of time?
5. And, after reading your post, I think eventually taper down to 0mg, given it's likely I've experienced "poop-out."

I definitely like the idea of not being on any psychiatric medications, as it seems I'll have a future of many more medications to come, given my autoimmune disorder diagnosis. So, I'll eventually get off the bupropion as well.

 

I have been doing some good CBT work with my therapist, and I plan to continue this. Thank you again for your support. If you have any experience to share that could guide me in deciding how long to hold at 15mg, I would really appreciate it.

[essenceofllama]

Hello @manymoretodays, and thank you for your detailed reply. I will answer your questions in order as best as I can.

 

Here's a bit of a timeline of recent events to help out:

11/14 - 20mg Lexapro (AM): intense side effects

11/15 - 17.5mg Lexapro (AM): slightly lower, but still intense side effects

11/16 - 15mg Lexapro (AM) + 150mg Wellbutrin XL (PM): WAY lower side effects, started to feel better, slept amazing

11/17 - 12.5mg Lexapro (AM) + 150mg Wellbutrin XL (PM): I noticed almost no side effects, best day I've had in a long time; my chronic pain was incredibly low and I just felt really good, but then slept really poorly

11/18 - 10mg Lexapro (AM) +150mg Wellbutrin XL (PM): had a good day, but slept terribly

11/19 - 10mg Lexapro (AM) +150mg Wellbutrin XL (PM): started to get emotionally unstable, pain started creeping back up to normal, slept terribly

11/20 - 10mg Lexapro (AM) +150mg Wellbutrin XL (PM) + 500mg Sulfasalazine (AM): depression, crying, loss of appetite, nausea, but all symptoms subsided 10hr after I took the Sulfasalazine, slept badly

11/21 - 10mg Lexapro (AM) +150mg Wellbutrin XL (PM): much more normal day, emotionally stable, normal appetite, slept badly

11/22 - 10mg Lexapro (AM) +150mg Wellbutrin XL (PM): normal day, but in the evening the withdrawal symptoms started hitting in full force - nausea, extremely violent vomiting, complete loss of appetite, no control of emotions, crying at any provocation, rapid and frequent temperature shifts, slept horribly

11/23 - 15mg Lexapro (AM) +150mg Wellbutrin XL (PM): couldn't get out of bed, couldn't look at a phone without wanting to vomit, had to get my husband to do research and set appointments for me; started noticing small improvements as each hour passed after taking my 15mg dose of Lexapro; this is the day I saw the PA who agreed to get me some extra 10mg Lexapro tabs to help me with my taper; slept amazing

11/24 - 15mg Lexapro (AM) +150mg Wellbutrin XL (PM): functional, able to get out of bed, but still not good, many withdrawal symptoms still present, slept badly

11/25 - 15mg Lexapro (AM) +150mg Wellbutrin XL (PM): functional, able to get out of bed, but still not good, fewer withdrawal symptoms present, noticed that the symptoms are the worst the hour before I take my Lexapro and the hour or so after while my serum level comes back up, slept great

11/26 - 15mg Lexapro (AM) +150mg Wellbutrin XL (PM): functional, able to get out of bed, but still not good, fewer withdrawal side effects still present, noticed that the symptoms are the worst the hour before I take my Lexapro and the hour or so after while my serum level comes back up

 

I started to feel relief of the side effects from 20mg almost immediately upon reducing the dose, and it felt like good things were happening for the first 4 days that I reduced my dose.

 

It's a bit confusing because I reduced my dose of Lexapro at the same time as adding Wellbutrin, but I perceived an added benefit from the Wellbutrin (in better quality sleep and reduction of pain), which I had never seen on Lexapro. The increase in Lexapro dosage happened 6 weeks before adding Wellbutrin. Then we decided to decrease my Lexapro dosage and add Wellbutrin around the same time. Very un-scientific, but desperation makes you make weird decisions. I will definitely read that how-to and summarize my drug history in my signature to make the timeline more clear.

 

I hadn't started putting together a long-term plan yet, but I think this is where I'm heading:

1. Survive these withdrawals
2. Stabilize on 15mg Lexapro (not sure how long I need to do this... 2 weeks? 6 weeks? more? I'd like it to be as short as possible because 15mg is still way too high for me - I do not like it.)
3. SLOWLY taper down to 10mg Lexapro, maybe stop to stabilize here for some period of time?
4. SLOWLY taper down to 5mg Lexapro, maybe stop to stabilize here for some period of time?
5. And, after reading Alto's post, I think I'll eventually try to taper down to 0mg Lexapro, given it's likely I've experienced "poop-out."
6. Then probably start this process over with the Wellbutrin, but hopefully without the withdrawals this time.

Thank you for the resource for checking my various prescriptions and their interactions. I'll definitely use it. And I'll work to update this post with my current drugs and interactions.

 

Yes, I was referring to the Lexapro with the 15mg dose. It is quite high, and I want to reduce it as quickly and safely as possible. As you mentioned before, I made the change back up to 15mg from 10mg without much knowledge or education; I just knew I couldn't survive how I was, and I needed to make the horrible withdrawal symptoms subside. Honestly, I'm not sure if going up by 0.5mg or 1mg would have helped; I'm still getting withdrawal symptoms in the 1-2hrs before and after my dose each day even at 15mg.

 

Thank you again for the resources - I plan to read all of them.

 

Today I am doing ok. I'm able to function and contribute to my family, I'm more emotionally stable, but still easily thrown into depressive thought patterns, I'm eating, and hoping for tomorrow to continue to improve. My next step is to figure out the shortest safe timeframe to stay at 15mg Lexapro before starting to decrease towards 10mg.

[Altostrata]

You should expect to hold at 15mg Lexapro -- if it doesn't prove to be too high a dose -- for at least a few months. How do you feel before and after taking each dose of Lexapro and Wellbutrin?

 

It will take about 4 days for Lexapro to get to steady-state in your bloodstream. It is unlikely that you will continue to get interdose withdrawal prior to taking your Lexapro dose. 

[essenceofllama]

I’m incredibly relieved to hear the interdose withdrawals should be coming to an end. That’s very reassuring. Thank you.

 

I honestly don’t feel good at 15mg Lexapro. I have racing thoughts, anxiety, obsessive thought patterns, difficulty falling asleep, I feel a buzzing sensation in my brain and all my nerves, my TMJ and restless legs are worse than normal, my ears are ringing, and I’m getting twitches in my thumbs. I still have nausea, get dizzy easily, and have sensitivity to light, but I’m not sure if this is lingering withdrawal symptoms or high-dose Lexapro side effects. I’d like to get down to 10mg as soon as possible; I didn’t notice any side effects at that dosage.

 

It’s hard to sort the Wellbutrin effects out from all of this, but I think I’m noticing an ability/desire to maintain my sleep schedule (whereas my anxiety frequently makes me postpone going to bed), it feels like it’s trying to counteract the Lexapro’s tendency to keep me from falling asleep, and I think most significantly, it is reducing my daily pain.

[manymoretodays]

On 11/26/2021 at 8:15 PM, Altostrata said:

How do you feel before and after taking each dose of Lexapro and Wellbutrin?

 

On 11/27/2021 at 7:37 AM, essenceofllama said:

It’s hard to sort the Wellbutrin effects out from all of this, but I think I’m noticing an ability/desire to maintain my sleep schedule (whereas my anxiety frequently makes me postpone going to bed), it feels like it’s trying to counteract the Lexapro’s tendency to keep me from falling asleep, and I think most significantly, it is reducing my daily pain.

 

Hi essenceofllama,

Give a try at some daily drug and symptom logs.  Those will help to answer Alto's question above.

Daily drug and symptom logs aka Notes:  Recording drug schedule and symptoms to track patterns and progress

Note the date, then times on the left, throughout the day.  On the right note symptoms, and all drug(s), any supplements, by name and dose.

Here's a sample note to help, except record your own stuff:

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 
6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

6 a.m. Woke with anxiety (but less than yesterday)

 

That will help a lot to figure out what is doing what right now.   And to sort out some of the effects.

 

Keep us updated too, please.  Thank you.

 

L, P, H, and G,

mmt

 

 

[manymoretodays]

On 11/26/2021 at 7:45 PM, essenceofllama said:

Today I am doing ok. I'm able to function and contribute to my family, I'm more emotionally stable, but still easily thrown into depressive thought patterns, I'm eating, and hoping for tomorrow to continue to improve. My next step is to figure out the shortest safe timeframe to stay at 15mg Lexapro before starting to decrease towards 10mg.

 

Hi again,

This is good ^.  At least partially.  I hope it continued.  Here's another link, that should prove helpful:

non-drug techniques to cope with emotional symptoms

There is a whole indexed list of various coping skills to try and practice.  It can really help a lot to hone up a skill set to help mitigate depressive thought patterns.

Maybe you have some that you already know and could utilize too.

So hoping things are going well enough for you, as we say......and don't be a stranger here.  You're among friends.

 

L, P, H, and G,

mmt

[essenceofllama]

Hello! I've been away for a bit because I returned to work on 11/29 after the Thanksgiving holiday, and it's been hogging every ounce of my spare energy. I took manymoretodays' advice and did a daily log yesterday. Here it is:

 

11/26-11/28 - noticed small improvements each day; realized if I cut screen time, meditated 2x/day, rested when I felt tired, and walked at least 8,000 steps, I felt better and could perform my daily tasks and still have energy to be present with my family

 

11/29 - best day I’ve had in a long time, first day back at work, pushed it too hard, by the end of the day I could barely function; it felt like my brain was shutting down; it felt like I have a brain injury; 8,600 steps, meditated 2x

 

11/30 - exhausting, difficult day; 5,069 steps, meditated 2x; set up my computer in my son's room so I could control the lighting better, but it's very non-ergo, so I anticipate pain in my future

8:30p - epsom salt bath

10:10p - took 150mg Wellbutrin
10:30p - ready for sleep

 

12/1 - had 3 telehealth doctor's appointments, felt very drained, 5,600 steps, meditated 1x

6:20a - toddler woke us up, went back to sleep
7:00a - woke up on my own, forgot to turn on sleep app/alarm, but feel like I slept well, woke up with a sore neck and back
7:20a - fed baby, feeling very worried about him
7:45a - so hungry
8am - cooking breakfast, tired, confused, lost frequently
8:10am - wave of nausea before eating (I usually attribute this to waiting too long from hunger to eating), ate breakfast, felt better
8:45am - took a brain nap (face mask and ear plugs)
9:05a - wrote down dietician appt wrong, got a call from her and got up to do telehealth appt
9:15a - took 15mg lexapro, 25mg spironolactone, 750mg nabumetone, 50mg dexilant
10:00a - therapy
11a - so tired, sensitive to light, somewhat dizzy and nauseous, took a nap until 12:45p
1p - fed the baby, still sensitive to light and feeling unsteady/shaky
1:45p - snack
2p - psychiatrist new patient appt, not a lot happened except giving her my history, seems like she believes I was in withdrawals, but (understandably) is having difficulty sorting out the root cause of my issues because I changed so many things at one time, and she's wondering if I could have bipolar?; feeling like time is passing really fast today
3:30p - brain nap, feeling spine pain and mental/physical exhaustion today
5:15p - dinner
6p - walk
6:45p - nauseous, sensitive to light
7p - confusion, difficult to perform tasks required to prep to shower myself and my baby
7:45p - headache, hungry
8p - snack, took 1000mg tylenol
9:15p - epsom salt bath
9:40p - snack
10:20p - took Wellbutrin 150 and magnesium gluconate supplement
10:40p - bed, took a while to fall asleep

 

12/2 - feeling tired and short tempered today, sensitive to light and sound, feeling a bit better after talking with the therapist and psychiatrist yesterday, but still worried that adding work back in is going to prolong or stagnate my healing
1:30a - woke up, felt nauseous, went back to sleep
6:55a - woke up a bit drowsy, neck and back still hurt

 

I hope this is useful. Let me know if you have any questions or insights. Thank you for the coping mechanisms resource - I will read it.

[Altostrata]

9 hours ago, essenceofllama said:

9:15a - took 15mg lexapro, 25mg spironolactone, 750mg nabumetone, 50mg dexilant

 

Why are you taking all these drugs at the same time? Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

How do you feel before and after you take Wellbutrin at 10:20 p.m.? Is it immediate-release Wellbutrin? 

 

When they can't figure out what's going on, psychiatrists always resort to considering bipolar disorder.

[essenceofllama]

I take them all at the same time because it’s easy to remember. The nabumetone is twice a day so I do 9a and 9p (just realized I forgot to put the 9p in my daily tracker). I have never considered spacing them out. Not sure why.

 

This week, before I take the Wellbutrin at night, I feel completely destroyed. I’m mentally and physically exhausted. I’m talking with HR about taking medical leave from work. About 30 minutes after I take the Wellbutrin I feel like a lot of the negative racing thoughts in my head are subsiding and I feel pleasantly ready to go to sleep.

It is the XL/extended release generic version.

 

I was getting that impression as well… I’ve been in therapy for about 10 years and no one has ever suggested I might have bipolar disorder. If she tries to diagnose me with it, I’ll be getting a second opinion.

 

I’ll try to do the interactions checker soon. I’m reaching my screen time limit for the day.

 

Thank you for your reply!

[essenceofllama]

I did a few versions of the drug interactions checker:

 

1) What I’m taking right now: https://www.drugs.com/interactions-check.php?drug_list=1013-565,440-2469,3107-14380,1674-0,2105-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication

 

2) What I’m taking + sulfasalazine (to see if I may have had a drug interaction when I took it): https://www.drugs.com/interactions-check.php?drug_list=1013-565,440-2469,3107-14380,1674-0,2105-0,2130-0

 

3) What I’m taking + methotrexate (my rheumatologist has officially diagnosed me with Ankylosing Spondylitis and Rheumatoid Arthritis, and since the sulfasalazine didn’t work for me, this is the next step): https://www.drugs.com/interactions-check.php?drug_list=1013-565,440-2469,3107-14380,1674-0,2105-0,1590-0

 

Note: the methotrexate sounds terrifying, so that’s fun. It’ll be a low dose injection (7.5-10mg) once per week. My rheumatologist said it causes fewer side effects and is more effective as an injection than oral. And he said I should continue taking the nabumetone as the MTX takes 6 weeks to start being effective, even though it looks like there is an interaction. Also the dexilant is a problem. I was on track to wean off the dexilant until all this antidepressant stuff started happening. Perhaps I’ll get back on that track. 
 

Any thoughts/comments are welcome. Thanks!

 

Edit: MTX is contraindicated for breastfeeding, so I’ll be waiting to start until after I wean (I’m going to start weaning tomorrow, but it’ll take a few weeks or so), and I plan to talk to the psychiatrist about any changes before doing anything.

[Altostrata]

We need to see more of your daily notes.

[essenceofllama]

Noted. I'm doing another daily tracker today; trying to focus more on how I feel than what I'm doing.

 

I had a follow up with my psychiatrist yesterday; she said she spoke with my OB and my Therapist, and she doesn't believe I have Bipolar Disorder, so that's a relief. She has prescribed me the liquid escitalopram so I can slowly taper. Her suggestion was to go down by 1mg per week until I get to 10mg and hold there, but I'm planning to discuss some journaling/tracking activities with my Therapist so I can monitor symptoms and decide the schedule that's best for me.

 

I spoke with my OB and my Dietician about getting off the Dexilant, and it sounds like I should probably wait until the Methotrexate is at full effect, so I can see whether it controls my RA symptoms enough that I don't need the Nabumetone 2x/day anymore. That'll be another couple of months at least.

 

I also started medical leave today. That's going to be very helpful; the weather is changing from warm to cold today and I'm exhausted.

[essenceofllama]

Hello! I've been away again because I've been in a pretty bad flare-up of my autoimmune disease. These kind of weeks make me antsy to start my Methotrexate treatment, but I'm trying to wait until we at least get down to 10mg Lexapro. Here is my Daily Log from last Thursday:

 

12/5 - hurt my back, started spasming, needed husband to help me sit/stand

 

12/6 - could barely walk from back spasms, gut feels awful from muscle spasms

 

12/7 - some improvements from chiro and massage

 

12/8
10:20p - Wellbutrin XL 150mg and magnesium
10:40p - bed
10:50p - baby awake, feed
11:40p - bed

 

12/9
2:30a - woke up to pee, CPAP bothered me so I couldn’t fall back asleep, took it off
7:04a - woke up, felt tired but ok, then anxious about 5 min after waking
7:34a - feed baby, always get a dump of hormones along with anxiety, nausea, and a need to move my body
8:10a - used racquetball to roll on gut bc stomach felt terrible
8:20a - so hungry
8:40a - breakfast
8:55a - noticed some rocking/hand wringing
9:00a - Lexapro 15mg, dexilant 60mg, spironolactone 25mg, nabumetone 750mg
9:30a - talked with medical leave company
10a - so. tired.
10:15a - meditate
10:30a - nap until 12:45p
1:15p - lunch
1:45p - anxious
2:00p - depressed thoughts
2:30p - chiro
3:30p - depressed thoughts
3:45p - anxious
4:15p - tired
5:20p - sad, anxious, tired
5:25p - dinner
6p - massaged gut, reduced discomfort, improved mood
7:30p - back sore after bathing baby, tired, not feeling much else
8:30p - so hungry, so tired
9p - snack and nabumetone
10:30p - Wellbutrin XL 150mg, magnesium; feeling tired, gut feels awful
10:55p - bed

 

I also spent last week fighting with my new APAP/CPAP machine, trying to get the settings right so I could tolerate it throughout the entire night. On the night of 12/12, I finally got it dialed in, and I've been sleeping much better since then. I've noticed a major improvement in my symptoms (both psychological and physical) since then, to the point where my therapist and I decided I'm ready to start trying to drop my Lexapro again - I'm using a mixture of 10mg pills and 5mg/5ml liquid to taper. I started 14mg yesterday morning 12/16. My psychiatrist's recommendation is to go down 1mg/week until I get to 10mg and then hold/do a check-in with her, but I'm using the Dr. Glenmullens symptom tracker to help me decide the exact timing of each reduction. I've also been doing much better since going on medical leave and focusing on my health by restricting screen time, walking, meditating, napping, and trying to manage my autoimmune symptoms with diet.

 

Thanks!

Edited December 19, 2021 by manymoretodays
No edit, was sharing- pressed wrong button(mmt)

[manymoretodays]

On 12/9/2021 at 3:08 PM, essenceofllama said:

I had a follow up with my psychiatrist yesterday; she said she spoke with my OB and my Therapist, and she doesn't believe I have Bipolar Disorder, so that's a relief. She has prescribed me the liquid escitalopram so I can slowly taper. Her suggestion was to go down by 1mg per week until I get to 10mg and hold there, but I'm planning to discuss some journaling/tracking activities with my Therapist so I can monitor symptoms and decide the schedule that's best for me.

 

Hi essenceofllama,

Nice.  To have someone in the medical arena endorse that you do not have a Bipolar Disorder.  Nicer still, if they acknowledge that some of their drugs cause more harm than help.  And I keep on hoping.......

I like that idea too, of going down by just 1 mg at a time, until you are at the 10 mg dose.

After your first taper, and waiting a full week or 7 days, or even a bit longer.......you might even try 2 weeks, you should be able to see, or observe if you are getting any WD symptoms.  Keep some notes for yourself too, so you know just what the pattern might be after you do a taper, and then how long until you achieve stability again.  It can be so helpful.  And you are using the Dr. Glenmullen checklist too.  Excellent.

 

 

And of course, keep educating yourself too, as you have been doing.  Re-read some of the initial topics I gave you, especially get familiar with the Why taper by 10% of my dose topic.  You'll see links on page one, in probably my first post to you there.

 

And oh my,  I just had a look at the Methotrextrexate at Drugs.com.

That is one heavy duty drug.

And I see that you realize that too.

https://www.survivingantidepressants.org/topic/26025-essenceofllama-intro-trying-to-find-a-balance/?do=findComment&comment=565040

 

You are very brave and courageous essence, and are doing just great.

I am sorry about the medical issues that you are dealing with on an ongoing basis.

 

Good Notes.  Thank you.  Whenever you can, post a couple days at once, delineating the date of each.......that might further help show any trends of symptoms, or make them more apparent.

Use:  AccountSettings/signature to get to your signature to edit in, any changes, like your recent taper to 14 mg of Lexapro.

You may need to consolidate a bit, some of the lines, to keep it within the 12 lines suggested, and easy to view for us all.

 

Best for your holidays with a little one! 

And don't be a stranger here.

 

L, P, H, and G,

mmt

💜

 

 

 

[Altostrata]

@essenceofllama can you explain more about these symptoms? How do they feel? How long do they last?

 

On 12/17/2021 at 10:01 AM, essenceofllama said:

....
7:34a - feed baby, always get a dump of hormones along with anxiety, nausea, and a need to move my body
8:10a - used racquetball to roll on gut bc stomach felt terrible
....
8:55a - noticed some rocking/hand wringing
....
6p - massaged gut, reduced discomfort, improved mood
....
9p - snack and nabumetone
10:30p - Wellbutrin XL 150mg, magnesium; feeling tired, gut feels awful
....

 

Please explain more about "always get a dump of hormones along with anxiety, nausea, and a need to move my body".

 

Do the gut symptoms come on suddenly? Do any particular thoughts precede the gut symptoms?

 

Please explain more about "rocking/hand wringing".

 

Do more gut symptoms occur about 6 and 10:30 p.m., or are they off and on throughout the day? Do you smoke tobacco? Take magnesium more than once a day? Have you had a test for h. pylori?

 

From your drug interactions report, you can see that the combination of drugs you take all together at 9 a.m. (Lexapro 15mg, dexilant 60mg, spironolactone 25mg, nabumetone 750mg) can cause low blood pressure and low sodium, as well as weakness, fatigue, etc. Your daily notes show "10a - so. tired." -- one hour after you take this drug combination.

 

Have you discussed this with your doctors? Do these adverse effects affect your mood? 

 

On 12/17/2021 at 10:01 AM, essenceofllama said:

....

My psychiatrist's recommendation is to go down 1mg/week until I get to 10mg and then hold/do a check-in with her, but I'm using the Dr. Glenmullens symptom tracker to help me decide the exact timing of each reduction. I've also been doing much better since going on medical leave and focusing on my health by restricting screen time, walking, meditating, napping, and trying to manage my autoimmune symptoms with diet.

....

 

By our standards, that would be a fast linear taper by 1mg/week or 26.7% per month. Since you had "violent withdrawal symptoms" only a few weeks ago, it's likely this is going to be too fast for you. It may take more than a week for you to assess the success of a reduction. How do you plan to use Dr. Glenmullen's checklist?

[essenceofllama]

@manymoretodays - Thank you for your comments and support; I really appreciate it. I may end up holding at 14mg Lexapro a bit longer than 7 days as you suggested... I'm taking it day by day, but I started noticing my anxiety come back right before bedtime last night, and it's been present most of today (Day 5 at 14mg). I'm also feeling some nerve buzzing and some difficulty concentrating. Last time around, Day 5 at 10mg was my worst withdrawal day, so hopefully this will be my peak WD symptom day and I'll stabilize as some more time passes.

 

I'm pretty sure the withdrawal triggered my most recent Rheumatoid Arthritis flare, which I've been in for almost 4 weeks now. I'm working on figuring out the best way to start the Methotrexate treatment for my RA while tapering. I'm exploring a couple of avenues: one is asking what the lowest dose I can start on would be, given that I'm very sensitive to medications; the other is considering holding at 14mg Lexapro for a few weeks while I add the MTX (or perhaps both). My hope is that I can either a) get my RA symptoms under control with the lowest possible dose of MTX, which will allow me to separate my RA symptoms from my WD symptoms more effectively, or b) find out as quickly as possible that MTX doesn't work for me so I can get the process of insurance approvals for Biologics started. The idea of delaying starting the MTX for months, while I'm actively flaring and in pain, while my body is accumulating damage, and then waiting for further weeks or months to determine whether the MTX even works, and then waiting for further weeks or months for insurance to approve Biologics is... daunting to say the least. 

 

On the plus side, I think I'm fully weaned from breastfeeding, so that's one thing off my plate. Thank you again - I'll continue to update through this process.

[essenceofllama]

@Altostrata - Thank you for your response! I'll do my best to explain and answer your questions.

 

The dump of hormones I always got while breastfeeding (oxytocin and prolactin) made me feel nauseous, anxious, and restless. This happened with both of my children: my daughter (no antidepressants, or any other pharmaceuticals) and with my son (all the meds). I'm all weaned now, so that's not going to be a factor going forward.

 

The hand wringing/rocking feels like a result of rising anxiety and racing thoughts, like my nervous system is trying to regulate itself.

 

The gut symptoms I've been having for the last few weeks are most likley a direct result of my autoimmune disease(s): Rheumatoid Arthritis and/or Ankylosing Spondylitis. I've been in a really bad flare ever since the withdrawals, which is why I'm getting antsy to start the Methotrexate. The gut symptoms appeared at exactly the same time I started having lower back spasms. I would say that over the last week, it does seem like the symptoms are the worst in the evenings before bed. I do not and have never smoked tobacco. I only take the magnesium once a day at night. I don't think I've had an h. pylori test recently, but I did have a colonoscopy in September 2021, and the GI Doctor said everything was normal: no evidence of bacterial overgrowth, no evidence of Celiac, no evidence of cancer, just a couple of tiny polyps.

 

I haven't discussed that potential issue with taking all of my meds together at 9am. I will send a message to my PCP and ask though! I would say that my mood is independent of this potential issue? After I got my CPAP sorted out, I noticed the time that I get tired each day has shifted later to more like 12-1p.

 

Honestly, this last paragraph makes me so anxious. I feel like I've been in a holding pattern with pregnancy, breastfeeding, and now the Lexapro taper that has been keeping me from properly treating my autoimmune disease. My psychiatrist, rightly, wants me to hold off on adding methotrexate until I'm stable at 10mg Lexapro, and with a 1mg/week taper, this feels somewhat doable. But after being in a flare for almost 4 weeks, I'm starting to feel desperation set in. I want to stop being in pain. I want to stop accumulating joint damage. I want my gut to stop flaring. I want my brain fog to go away. If I have to do all of these things in series, and if I have to wait multiple weeks per reduction, then all of those symptoms will continue. Starting the MTX while actively tapering sounds like a terrible idea, so I'm considering a 3rd option: holding at 14mg Lexapro for a few weeks while adding the MTX.

 

I plan to use the checklist to track my symptoms and help me decide the right timing to reduce my dose. I think I've determined which symptoms are my normal depression, which are WD, and which are my RA/AS, so if I see the WD symptoms increase, I'll wait until they decrease again before I drop my dose.

 

Thank you again!

[Altostrata]

2 hours ago, essenceofllama said:

I would say that my mood is independent of this potential issue?

 

Please note we do not treat mood issues here. The reason I want to see your daily notes is to identify possible drug adverse effects, which may affect your mood, your gut, and your general sense of well-being. 

 

My guess is some of your physical problems, which understandably cause you emotional distress, are in fact caused by your drug combination. Because your health issues are a constant worry, this may exacerbate your "mood issues" as well as your physical condition. If potential adverse drug effects were addressed, you might feel somewhat better.

 

I still want to know more about what "rocking/hand wringing" means. Is this an involuntary physical movement? You also reported it here:

On 11/24/2021 at 6:40 AM, essenceofllama said:

Six weeks later, the weekend of 11/13 and 11/14/2021. I started realizing I was having intense side effects: agitation, confusion, restless legs if I sat or laid down for more than 2 minutes, rocking, hand wringing, inability to think logically from point A to point B, obsessive behaviors.

 

Does "rocking/hand wringing" consistently happen before or after you take Lexapro in the morning?

 

On 11/24/2021 at 6:40 AM, essenceofllama said:

We also decided that since 10mg Lexapro wasn’t fully controlling my symptoms

 

To what symptoms are you referring here? Was your prescriber aware you were already taking a handful of other drugs? The addition of Wellbutrin might have been unnecessary.

 

In general, from what we see here, postpartum depression is vastly overdiagnosed and overtreated. I would not assume  that this is a long-term condition or even that it was a correct diagnosis. Clearly, you are very much affected from the hormones involved in nursing, this may also have applied to pregnancy. As your due date came near, you may well have become more anxious about the impending increase in physiological stress, work, and responsibility.

 

There are many reasons why women might become "depressed" about childbirth, particularly in the US where they are not afforded any assistance from society in general and may be left by their families to attend to childcare alone.

 

We also do not treat autoimmune conditions here. We can't tell you what drug therapy is best for you. However, our members are very often taking multiple drugs on very dumb schedules that indicate their doctors have never even thought of potential drug-drug interactions or the drug burden at all. Very few doctors would have the sense to even ask how you feel before and after taking 4 powerful drugs at once, with another (Wellbutrin XL) hanging around in the background to gum up the works further.

 

Please do ask your doctors hard questions about why you are taking 25mg spironolactone, 750mg nabumetone, and 50mg dexilant TOGETHER with Lexapro at 9:15 a.m. Do these drugs have to be taken together? Are there better times of day to take any one of spironolactone, nabumetone, and dexilant? Some drugs are better taken in the morning, some at night, some with food, some not with food, etc. Did any of your doctors inform you of this?

 

For our purposes, I would like you to separate Lexapro from the others in the morning, either by moving Lexapro several hours earlier or later, or by moving the other drugs to other times. These changes have to be made gradually and systematically by moving one drug by an hour each day.

 

This change in schedule is to identify adverse reactions emanating from one or more of your drugs, which your doctors may well be confusing with symptoms of your medical conditions or purported mental condition. We see this all the time, by the way. Drug prescription is too complicated for doctors, you (the patient) have to educate yourself about the drugs in order to practice your own version of defensive medicine.

 

 

 

[essenceofllama]

18 hours ago, Altostrata said:

Does "rocking/hand wringing" consistently happen before or after you take Lexapro in the morning?

 

When I was taking 20mg Lexapro, the rocking/hand wringing side effect was almost constant; it's one of the things that made me realize I was having adverse side effects from taking too high of a dose. Since reducing to 15mg and now 14mg, I only notice the rocking/hand wringing when I feel my anxiety and stress levels rising. This can happen before or after I take my dose of Lexapro at 9am each day, at any time of day. Do you have any additional questions so I can try to clarify further?

 

18 hours ago, Altostrata said:

 

To what symptoms are you referring here? Was your prescriber aware you were already taking a handful of other drugs?

 

The symptoms I am referring to are my PPD/MDD symptoms (I've had depression/anxiety since about 5th grade, but it was worsened to the point where it was negatively impacting my life, work, and relationships after having my first child. Yes, my prescriber was aware; she had prescribed some of the other meds.

 

18 hours ago, Altostrata said:

Please do ask your doctors hard questions about why you are taking 25mg spironolactone, 750mg nabumetone, and 50mg dexilant TOGETHER with Lexapro at 9:15 a.m. Do these drugs have to be taken together?

 

I will do that - I would also like to provide some insight to the dosing schedule; here's a timeline of how these drugs were added:

1. Other than the allergy meds (Zyrtec and Singulair, which I am no longer taking), Dexilant was the first medication that was added around my pregnancy. My first trimester with my 2nd child (Summer 2020), I had HORRIFIC reflux. To the point where I couldn't eat or sleep or work or do anything. We went through all of the pregnancy-approved OTC meds, and none of them even touched it. We tried one Rx med, and it made me sicker, so this allowed my OB to get prior approval from my insurance to try Dexilant. It was the only thing that worked after months of trying. It was my only daytime med, so I took it at breakfast.
2. At week 34 of my pregnancy, we added 5mg Lexapro (December 2020). I was told it makes some people sleepy and keeps some people from sleeping, and I wouldn't know which I was until I tried it. I know that not sleeping SEVERELY exacerbates my anxiety and depression, so I tried the morning first, and it worked, so I left it.
3. After giving birth, my autoimmune disease was causing me level 7-9 pain on a daily basis, even with OTC NSAIDs, so my old rheumatologist and I tried 2-3 Rx NSAIDs until we landed on Nabumetone, which brought my pain down to level 2-4 on a daily basis, which was manageable for me (this whole process spanned spring through fall of 2021). She told me I "just" had fibromyalgia, and the only other things she could give me (muscle relaxers or Cymbalta) were not breastfeeding safe, so I would have to wait. I have to take the Nabumetone twice a day and based on my schedule with the kids and wanting to keep my last dose at least an hour from bedtime, I added the first dose to breakfast and the 2nd dose at 9pm with a snack.
4. Then, I started having an extremely swollen and painful gland in my groin, for which my OB prescribed the Spironolactone (Fall 2021). She told me to take it in the morning because it's a diuretic and I would likely be woken up throughout the night to pee.
5. The Wellbutrin was added when my OB decided to reduce my dose of Lexapro from 20mg to 10mg. Honestly, the logic is a little fuzzy for me because my brain was not in the best place on 20mg Lexapro. I decided to take it at night based on some things I read online.

18 hours ago, Altostrata said:

Some drugs are better taken in the morning, some at night, some with food, some not with food, etc. Did any of your doctors inform you of this?

 

I would say in general, the food aspect was emphasized, but not much else.

 

18 hours ago, Altostrata said:

For our purposes, I would like you to separate Lexapro from the others in the morning, either by moving Lexapro several hours earlier or later, or by moving the other drugs to other times. These changes have to be made gradually and systematically by moving one drug by an hour each day.

 

I will work on this. My current plan is:

1. Taper off of the Spironolactone to see if I still need it (I started 12.5mg today, probably will taper for a couple of weeks)
2. Move the Dexilant to later in the day (I moved it to 10am today, and will try to get it to probably 12p?)
   1. Note: Today, I felt much better when I woke up than yesterday, and after breakfast and only taking the Lexapro, Nabumetone, and reduced dose of Spironolactone, I still felt good and like I had energy to do an item on my to-do list. Then, 1 hour after taking my Dexilant, I felt (and still feel) very tired. So that's interesting.
   2. In the future, I plan to get off of the Dexilant, but this is somewhat complicated. You probably know that you can't just stop taking PPIs, or you'll get rebound reflux, so I'm going to work with my Dietician on how to safely/slowly get off the Dexilant. However, since I'm taking a strong NSAID for my autoimmune disease, my OB wants me to stay on the Dexilant until the Methotrexate (hopefully) gets my RA/AS symptoms under control to the point where I don't need the Nabumetone twice a day to manage them. I would like to look into whether an OTC/non-PPI heartburn medication might be sufficient to protect my GI tract while I'm still on the Nabumetone so I can possibly start that process earlier.
3. I plan to leave the Nabumetone and Lexapro both at the same time at breakfast. Moving them around seems to have the potential to either affect my sleep or interfere with my kids' wake-up/bedtime routines, and that doesn't feel feasible for me right now. I'll see what I can do moving forward, though.

18 hours ago, Altostrata said:

This change in schedule is to identify adverse reactions emanating from one or more of your drugs, which your doctors may well be confusing with symptoms of your medical conditions or purported mental condition.

 

I'm reaching the limit of what my wrists can do as far as typing, but I want to address this last point. I agree that I likely have drug-drug interactions going on that are exacerbating my symptoms, and that resolving these will alleviate some of the worsening symptoms I'm noticing. I also value your input on building this skill for myself as I move forward, because I believe I will have many medications to contend with in my future. I would, however, like to emphasize that I've had MDD/GAD symptoms since around 5th grade, and that I've had RA/AS symptoms for the last 10-15+ years; all of these conditions have been worsened by my pregnancies/births/medication interactions, but I strongly believe that they were pre-existing, before the pregnancies or medication interactions occurred. I have been drilling my new Rheumatologist on whether my RA/AS-related symptoms could "just" be from my depression, and his response was (paraphrasing): "while depression can cause pain/make it worse, and RA/AS can cause/worsen depression, your bloodwork, family history, symptoms, and the fact that your symptoms improve with NSAIDs are all key markers for this diagnosis."

 

Thank you again. Let me know if you have any comments or questions.

[Altostrata]

4 hours ago, essenceofllama said:

I would, however, like to emphasize that I've had MDD/GAD symptoms since around 5th grade, and that I've had RA/AS symptoms for the last 10-15+ years; all of these conditions have been worsened by my pregnancies/births/medication interactions, but I strongly believe that they were pre-existing, before the pregnancies or medication interactions occurred.

 

We do not treat any of these conditions here. All we do is help people taper drugs and deal with withdrawal symptoms. Usually, our members want to unpatient themselves and leave their psychiatric diagnoses behind, "pre-existing" or not.

 

To be honest, we are not a free, auxiliary source for drug interaction advice, either -- that is what you pay your doctors to do although, admittedly, they are terrible at it.

 

You seem committed to your psychiatric diagnoses. For all I know, the drugs may be miracle drugs for you, though none of your doctors seems to know what they're doing when it comes to psychiatric drugs.

 

On 11/24/2021 at 6:40 AM, essenceofllama said:

I spoke to my prescribing doctor on 11/15, and she agreed we should reduce the dose, but did not think I needed to taper because I’d only been on 20mg for 6 weeks and I wasn’t going completely off the drug. We also decided that since 10mg Lexapro wasn’t fully controlling my symptoms, we would add 150mg Wellbutrin XL. I decided to do an even shorter taper after our discussion and just did 1 day each of 17.5mg, 15mg, 12.5mg, and finally 10mg on 11/18.

 

Clearly, your prescriber knows nothing about tapering psychiatric drugs. Your challenge is to reduce Lexapro in a tolerable way. See Tips for tapering off Lexapro

 

While we can help you identify withdrawal symptoms, which would indicate you need to taper more slowly, we cannot address your medical conditions. Please let us know how you're doing.

 

 

 

[essenceofllama]

2 hours ago, Altostrata said:

We do not treat any of these conditions here.

 

Noted - My intention is to provide as much information as possible in case it is helpful. If it is not, please feel free to ignore.

 

2 hours ago, Altostrata said:

All we do is help people taper drugs and deal with withdrawal symptoms.

 

Understood! This is why I came to this forum - I want to safely get off the Lexapro because I agree with your assessment that it's doing nothing for me anymore. I will likely eventually want to get off the Wellbutrin as well.

 

2 hours ago, Altostrata said:

we are not a free, auxiliary source for drug interaction advice

 

Noted - I appreciate the information I've received on this topic, but I will continue to do my own research.

 

3 hours ago, Altostrata said:

You seem committed to your psychiatric diagnoses.

 

I'm just doing the best I can in this moment. Maybe when I get my autoimmune disease under control, I'll find out I don't actually have depression and anxiety; it's just been the inflammation all along.

 

2 hours ago, Altostrata said:

Clearly, your prescriber knows nothing about tapering psychiatric drugs.

 

Agree. My original prescriber was my OB, and since the WD episode, I have started care under a Psychiatrist who is now helping with my Lexapro taper.

 

I'll continue to update. Thank you again for your input!

[manymoretodays]

Hi essenceofllama,

Just wanted to check on in, and see how you are doing this week?

Hope the holidays are agreeing with you and yours too.

So far so good around here and for me.

I'm just finding this Monday after Christmas to be flying.  I just looked at the clock and am like oh hey, where did my day go??

Okay, hoping well enough.

 

L, P, H, and G,

mmt

[essenceofllama]

Hi, manymoretodays!

 

We're all doing well, thank you for checking in - happy to hear the holidays are going well for you too.

 

I'm working through my Lexapro taper, and I think it's going well. I'm at 13mg now. No severe WD symptoms so far; my "worst" days are days 4-5 after dropping my dose, but they're pretty mild.

 

I've tapered off of the Spironolactone, and I think that's helping me feel better as well. Just crossing my fingers that the swollen gland doesn't come back now.

 

I talked to my pharmacist about starting Methotrexate, and she pointed out a severe interaction between the Nabumetone, Dexilant, and Methotrexate (both Nabumetone and Dexilant increase blood levels of MTX, and potential issues caused by this should be actively monitored by my doctor). So, I'm working with my providers to get off the Dexilant before starting the MTX (getting off the Nabumetone isn't an option because it's the only thing somewhat keeping my RA symptoms in check). I'm hoping to start the process of getting off the Dexilant this week by switching to Famotidine + Tums as needed to try to combat the rebound reflux, and then eventually coming off the Famotidine. This path is my only real option because all of the OTC proton pump inhibitors interact with Lexapro by increasing blood levels of Lexapro... which is the opposite of what I want.

 

Thanks again for checking in - Happy New Year!

[essenceofllama]

Updates!

 

I'M COMPLETELY OFF OF LEXAPRO!! I cannot describe how much better I feel. I did a 1mg/week taper because it's what felt right for me, and overall it went really well. Basically every time I dropped my dose, I felt better and better (except the 12mg week; that week I felt unstable, so I held for a few extra days). [NOTE: I am not advising anyone else to do this; I kept a detailed journal of my symptoms, listened to my body on a daily basis, and checked in with my Therapist and Psychiatrist weekly throughout my taper. This is what I did, and it is not medical advice - please follow the 10% taper recommendation from this community.]

 

I'm still on 150mg Wellbutrin XL, which I take at 10pm daily, and I'm strongly considering tapering off of it soon as well. I somehow missed a dose recently, and the following morning I felt really good; it was easy to get out of bed, I didn't feel completely exhausted like I usually do... it was really nice. But then about an hour or so later (around 8am), I started having withdrawal symptoms. I was SO angry, anxious, agitated, depressed. I also had suicidal thoughts. I didn't realize until 10pm that night that I had missed the previous night's dose, so I took it that night, and woke up SO TIRED the next day, but the withdrawal symptoms were gone. So, that little unintentional experiment solidified for me that the "skip a dose" method is absolutely not going to work for me, and I'll be working with my Psychiatrist to taper more slowly using advice from this post. I'm confident that I want to do this and that I have the tools to do it; now I just need to work on the timing, because...

 

I have a new tapering problem to tackle: I've been on Nabumetone 750mg 2x/day for almost a year, and the good news/bad news is: my Rheumatologist says I'm ready to come off of the Nabumetone because my Humira is working! But then he followed that up with the fact that coming off NSAIDs after long-term use can cause withdrawals. Yay. This makes sense because I've experimented with skipping doses to see if I'm ready, and it was BAD. Obviously the pain increased, but I was also angry, anxious, and depressed. I thought this was just because of the pain, but it turns out it might be from NSAID withdrawals. His advice was to drop one dose per day for a while and use Acetaminophen (1000mg AM and 1000mg PM) to manage the rebound headaches, but I don't think that's going to work for me. This article gives some good data on half lives of various NSAIDs, which I'm using to help form a tapering plan. It suggests that you reach steady state with Nabumetone after stopping it for 6 days, so I'm going to round that up to a week for ease of use. I'm considering one main option right now:

1. Reduce my dose of Nabumetone to 1x/day and add OTC Naproxen 1x/day for a week, then go to just Naproxen 2x/day for a week, then use Advil to get off the Naproxen, and use Acetaminophen as needed 

I thought about some other options, but they seem overly complicated. My idea behind adding Naproxen is that since it still works on those COX pathways, it'll help mitigate WD symptoms. I would approve any plans to mix NSAIDs with my doc before doing anything.

 

After that, I want to taper off of my Pepcid. I'm going to link this thread in case it's helpful in the future.

 

So, overall, really positive outlook, but there's still more work to be done...

[Ariel]

Hi @essenceofllama

Congratulations on being off lexapro. I am also a lexapro/escitalopram survivor. 

 

I'm not a mod, but based on my personal experience I'd just like to reach out and share. I am suffering from protracted withdrawal from a too-fast taper of lexapro over 4 years ago. Thanks to SA I have since learned that lexapro is one of the most potent SSRIs out there. I had a lot of trouble with post-acute withdrawal symptoms, intense waves that hit months and even years after I was past the zero mark. I do not say this to scare you, just to give you a heads up, from a place of care and solidarity. While I'm not an expert your taper strikes me as being pretty fast. Seems to me it would be a good idea to slow down and give your nervous system lots of time and space to stabilize. Heightened sensitivity and reactivity can remain for a lot longer after we jump off a drug. Treat yourself extra gently, avoid stress, nourish yourself, pay attention to what your body is telling you. 

 

I wish you all the best -- good luck on your healing journey <3

A. 

 

[essenceofllama]

Thank you so much for sharing your experience. I will continue to remain vigilant and watch for any issues that arise.

 

Side note: I just realized my signature is wrong; it should say I came off in March. I’ll go correct that today.

 

How have you managed your protracted withdrawal symptoms?

 

Thank you again. I appreciate your advice and support.

[Altostrata]

@essenceofllama you tapered from 15mg escitalopram, correct? With 1mg reductions every week? How long did it take you to go off?

 

Did you make any other drug changes while tapering escitalopram, such as in Nabumetone, Humira, or other drugs?

 

Fatigue from bupropion is unusual, it usually is activating. If you take it at night, it's possible you get tired the next day when it wears off. You might benefit from taking it earlier in the day, by moving it by one hour at a time, so when it wears off, it's nighttime. Please observe the effect.

 

On 5/3/2022 at 10:38 PM, essenceofllama said:

So, that little unintentional experiment solidified for me that the "skip a dose" method is absolutely not going to work for me

 

Good you're not doing this.

 

On 5/3/2022 at 10:38 PM, essenceofllama said:

1. Reduce my dose of Nabumetone to 1x/day and add OTC Naproxen 1x/day for a week, then go to just Naproxen 2x/day for a week, then use Advil to get off the Naproxen, and use Acetaminophen as needed 

I thought about some other options, but they seem overly complicated. My idea behind adding Naproxen is that since it still works on those COX pathways, it'll help mitigate WD symptoms. I would approve any plans to mix NSAIDs with my doc before doing anything.

 

Sorry, we don't know anything about tapering nabumetone, you haven't listed all your drugs in your signature. If you're taking multiple doses a day, dropping one of the daily doses per week (allowing for that 6 days of adjustment to the new lower level), may be sufficient.

[Ariel]

Hi @essenceofllama

 

I "tapered" off of escitalopram over the course of six months, under the supervision of a psychiatrist. I put "tapered" in quotes as I have since learned that it was a much-too-fast taper comparable to cold turkey (CT). I went from 10mg to 0mg in half a year. My psychiatrist considered this to be conservative. They were wrong. To the body it's essentially CT. My brain, nervous system, all systems have been scrambling ever since. 

 

On 5/4/2022 at 2:17 PM, essenceofllama said:

How have you managed your protracted withdrawal symptoms?

 

I'm in my fifth year of protracted withdrawal, and managing any symptoms is a daily practice. Overall there are significant improvements compared to the first several years, when things were at their worst. I am still unable to work or engage with the world in any consistent, meaningful way. Functional disability is a daily challenge that I live with as best I can.

 

I guess I'm not sure how to answer your question about how I manage my symptoms... I do so in any way I possibly can, because I have to. My withdrawal-afflicted life more or less revolves around symptom management. If you're curious to know more about me or some of the strategies I use, you are welcome to peruse my intro thread. Basically I practice many of the same non-drug coping techniques described here on SA. Should you have questions about anything specific, feel free to ask. If you type in my name @Ariel anywhere in a post, I'll receive a notification that you've tagged me and will know to pick up your message. 

 

In regards to symptom management in general, have you had a chance to check out the help topics yet? This place is a veritable treasure trove of a self-care toolkit. 

Here are links to a few of my favorite help topics (and there are so many more... I encourage you to explore the site at your leisure).

 

 

Kind wishes, essenceofllama, go gently,

A.

[Ariel]

@essenceofllama

 

Last but not least, I extend my empathy and support for what you are going through. Two pregnancies, two small children, navigating motherhood and nursing and newborns and major biochemical, physiological, lifestyle shifts -- these are all big life changes for anyone. I'm sorry that you have been struggling with post-partum depression on top of that, and now with complications of psychiatric medications thrown into the mix. It's a lot, and I hope you give yourself credit for your courage and strength on this journey. 

 

The good news is you are absolutely in the right place when it comes to seeking guidance and resources related to psychiatric drug withdrawal. I trust you will continue to find the help you need and things will improve for you. Healing is possible, it is happening all the time. 

 

In solidarity, 

A.

[Ariel]

Hi @essenceofllama

Thinking of you and wondering how you're doing... 

Kind wishes,

A.