vetinari: Sleepy no more? Tapering off Lexapro w/ bupropion on board

[vetinari]

I'm female, 25. I've been on varying doses of Lexapro since I was 12 and had bad OCD. I have conflicted feelings about Lexapro overall because I believed it saved my life as a child. Since about the same age (it feels so obvious in retrospect) I've had severe, severe unexplained fatigue--sleep studies came up with nothing and I sleep 8-10 hours a night w/ an hour/hour and a half nap at midday. My libido has also taken a hit in the past year which is no fun. I read the article in the Nation and hope to begin tapering off the Lexapro very very slowly. At multiple times as my stress level has waxed and waned over the years I've jumped doses dramatically--like from 20 mg straight to 10 mg--without any problems, which I hope bodes well for this journey, but I'm not taking any chances. 

 

Since about 20yo I've also been taking bupropion (sometimes XL, SR or just normal release, or a combination of two at the same time). Right now I'm on 150 mg bupropion XL and plan to leave it there while we deal with Lexapro first. 

 

I live in Europe so it's challenging to find the right resources (what's a compounding pharmacy called in this country? ARE there any English-speaking psychiatrists to supervise me?). I don't want to be out here on my own, unmonitored, but the waitlists for psychiatrists are at least 4 months here and I feel such urgency to start my taper because I could finally be AWAKE again after 10 years. My current plan is to try to see a private psychiatrist outside of the public health system and ask them or my GP for the liquid version of Lexapro (only the 20mg/1mL version available here so I'll have to dilute). 

 

Would really appreciate any words or encouragement and/or success stories!! I must admit I'm quite scared... 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  You have come to the right place. 

 

Can you please give us specific information in your signature about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Are you aware there is a major interaction between Lexapro and bupropion?  Here is the information from drugs.com: 

 

Interactions between your drugs

Major

buPROPion  escitalopram

Applies to: bupropion, Lexapro (escitalopram)

Talk to your doctor before using buPROPion together with escitalopram. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of escitalopram, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. 

 

 

Here is some important information about how these drugs actually work.  This explains why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is.  If you taper properly, you can reduce your chances of experiencing withdrawal.  

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

I know you said you want to taper the Lexapro first. Please read this link, and see whether it would be best to taper the bupropion first, or the Lexapro first.  However, I'm thinking since your extreme fatigue started at the age you started the Lexapro, this may be the one to taper off of first.  It's up to you. 

 

Taking Multiple Psych Drugs - Which to Taper First

 

These links go into how to taper each of your drugs.  Please only do one taper at a time.  

 

Tips for Tapering Escitalopram/Lexapro

 

Tips for Tapering Bupropion/Wellbutrin

 

Here is a link with checklists of common WD symptoms, which you can hopefully avoid by tapering very slowly and cautiously: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and let us know what you think, or if you have any questions.  

Edited April 30, 2022 by getofflex

[getofflex]

On 4/29/2022 at 4:37 AM, vetinari said:

At multiple times as my stress level has waxed and waned over the years I've jumped doses dramatically--like from 20 mg straight to 10 mg--without any problems, which I hope bodes well for this journey, but I'm not taking any chances. 

We strongly suggest you do not jump around on your dose of Lexapro based on stress or anything else, unless you are reducing your dose for a taper in a planned cautious manner.  This will tend to destabilize your nervous system, and could cause very uncomfortable symptoms, and make it very difficult to taper off.  As you should have seen from the first video in my first post, Lexapro does not work like an ibuprofen, it actually changes the architecture of the nervous system.  You may have gotten away with this before, but these things have a way of catching up with us, and causing problems down the road by sensitizing our nervous systems.  

 

Question:  What dose of Lexapro are you currently taking? 

 

Here is a link with names of medical professionals who are knowledgable about psych med tapering: 

 

Recommended Health Care Professionals

 

 

Edited April 30, 2022 by getofflex