UncleRay: Lexapro too fast taper

[UncleRay]

First post here and found this site the hard way.  Apparently going from 10 to 5mg Lexapro was a bad idea.  I did this once before and didn't have any issues but this time was much worse.  Is this typical?  Today is 5 weeks since dropping and struggling with lots of symptoms like derealization, depression, nausea, anxiety, brain fog, vivid dreams, etc.  Not sure if I should try and tough it out or reinstate to some level.  I'm on generic escitalopram and the pills don't split real clean.  I can get them in half okay but would be worried trying to get them in quarters if I were to bump up to 7.5mg or something else.  Any advice??

[Shep]

Hi, UncleRay.

 

Welcome to Surviving Antidepressants.

 

Yes, you're correct that going from 10 to 5 mg is likely causing problems. I'm very glad you found this site.

 

We recommend tapering by no faster than 10% a month, based on the prior month's dose (not the original dose). 

 

Since it's only been 5 weeks since your reduction, you may want to try for 7 - 8 mg. It sounds like you have the 10 mg pill size, is that correct? If you can get the 5 mg pills, you could take one and a half pills to get to 7.5 mg. 

 

The easiest way to taper is with liquid and Lexapro does come in liquid in the US, so you may want to ask your doctor for a prescription liquid. Or your can make your own liquid. The instructions for this are in the first post of this thread:

 

Tips for tapering off escitalopram (Lexapro)

 

Please have a careful read of the first post in the above link. Lexapro is an extremely potent drug, so even at what appears to be a low dose, is still very powerful. 

 

Please also see these links: 

 

Why taper by 10% of my dosage?

The Windows and Waves Pattern of Stabilization

 

Please use this thread to document your taper and to ask questions. 

[UncleRay]

Hi Shep,

Thanks for taking the time for the thorough response.  Yes I was on a 10mg dose.  This Saturday will mark 6 weeks since dropping from 10mg to 5mg.  I probably should have reinstated earlier to 7 or 8 like you suggested but I didn't know any better.  I feel like the last two days I have felt some improvement so I'm going to hold at 5mg for now as its easiest to just split the pills in half.   After 3 or 4 months if I feel I'm ready to taper further I will follow the 10% guidance from now on and will either get a liquid script or dissolve my pills.  Weird that I tapered quick once before from 10 to 5 to 0 with only minor symptoms and this time its a much rougher ride.  I guess this is to be expected the more times we mess with our heads the more cranky it gets.  Thanks again!

[Shep]

18 hours ago, UncleRay said:

Weird that I tapered quick once before from 10 to 5 to 0 with only minor symptoms and this time its a much rougher ride.  I guess this is to be expected the more times we mess with our heads the more cranky it gets. 

 

I like the way you phrase this - "the more times we mess with our heads the more cranky it gets."

 

That's a great explanation for kindling, which is trauma to the nervous system from repeated withdrawals. 

 

So you'll likely want to go slow, perhaps even a microtaper, when you stabilize and continue your taper. 

 

 Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide Method of Micro-tapering

 

If you find that you're handling a micro-taper without any symptoms, you can always increase up to the 10% rate, but starting lower may be best to test the waters. 

 

You may want to read over these links as you're holding so you can set up a game plan for when you're ready to taper. 

 

18 hours ago, UncleRay said:

 I feel like the last two days I have felt some improvement so I'm going to hold at 5mg for now as its easiest to just split the pills in half.   After 3 or 4 months if I feel I'm ready to taper further I will follow the 10% guidance from now on and will either get a liquid script or dissolve my pills. 

 

Please note that SSRIs are notorious for a delayed withdrawal. Some people report not having any withdrawal symptoms for several months after coming off. So if you feel you're getting worse at 5 mg, you may want to quarter your pills and add an estimate of 2.5 mg (for a total of 7.5 mg) until you can get a more reliable way of getting your dose with a liquid prescription or a do-it-yourself liquid. 

 

Please let us know how you're doing over the coming days. 

Edited June 24, 2022 by Shep
added information

[UncleRay]

Today makes 8 weeks since dropping to 5mg, things seem be SLOWLY improving.  The DP/DR symptoms have settled a good bit.  Going to continue holding here, will check back in after a couple more weeks.

[Shep]

Thanks for the update, @UncleRay Glad things are improving. 

[UncleRay]

I haven't posted in a long while as I went back up to full dose over a year ago.  But I am finally starting an appropriate 10% taper.  My question is what is the shelf life of the generic liquid Escitalopram 5mg/5ml solution.  I have attached a picture of the container.  Just curious as I actually filled this Rx about 6 months ago but just started the taper 3.5 weeks ago.  I definitely had a few rough days and was wondering if it was the taper or if the drug actually wasn't as strong since I've had it for awhile.  Thanks!

[manymoretodays]

  

6 hours ago, UncleRay said:

What is the shelf life of the generic liquid Escitalopram 5mg/5ml solution?  I've had some for over 6 months and used it and got some w/d symptoms.

 

Did you do a cross over at all?  Perhaps unaware that a crossover is always a good idea?

Cross over from tablet to liquid OR changing the brand

And it is a good idea not to taper while you adjust to the liquid during the crossover, and for perhaps at least a week or two after.  Scroll down on the first page of the link and you'll see what's recommended ideally.  Sometimes, one has to modify a bit.

 

You should check with the pharmacy or manufacturer to find out the expiration date for sure.  I also had a generic liquid escitalopram 5 mg/5mL way back.  And the expiration date on the bottle was just shy of a year, with keeping it at recommended temperatures. 

If you can't find the expiry date on the bottle, call the pharmacy that dispensed the medication.  You want to know the expiry date after it's been opened.

 

We do have another topic:

Question and answers about liquid medications, use by date, expiry 

 

 

What symptoms did or are you experiencing?

If it was me, I might go back to 9 mg of liquid escitalopram(5mg/5mL) as it's only been one or two days now on 8.1mg    Give your body a bit more time to adjust to both the change to liquid and the first taper. 

 

Me, I wouldn't updose past 9 mg now.......as it's almost a month since you switched from tablet to liquid.  I think, I don't really know for sure.  And I wouldn't taper until you are free of WD symptoms.  And know that you don't have to taper by a full 10% of each previous dose.  I do see links to doing different percentages above.

 

I think it's unlikely that your liquid has expired, but totally worth it to find out when it does for sure.

 

Happy to hear you did stabilize on first 5 mg and then a 10 mg escitalopram tablet, and felt ready to begin to taper.  How long did it take to stabilize UncleRay since you last posted? 

 

Don't be a stranger, keep us updated. 

 

Love, peace, healing, and growth,

manymoretodays(mmt)

 

 

 

 

[Tulip52]

From my experience the liquid hits a lot quicker and harder.  What I find that helps is to take it with food.  

[UncleRay]

I unfortunately did not do a crossover taper.  I honesty forgot that was the suggested way to switch to liquid.  I sorta remembered from awhile back that to not taper when switching from pill to liquid and stay at same dose but I convinced myself I didn't need to do that,  so I went straight from a 10mg pill to 9mg liquid.  Held there for 3.5 weeks and dropped to 8.1mg two days ago.  @Athena also suggested the same as you to bump back up to 9mg and hold and I will take the advice.

 

I did talk to the pharmacy today and they confirmed the expiration is at least a year.  They get the solution already prepared and just move it to a new container for the prescribed volume.  So sounds like it was too much change for me and not expired medication.

 

I felt fine for the first two weeks but then had significant fatigue, brain fog, some dizziness, trouble sleeping, sometimes felt like the battery was pulled from my brain.  No anxiety though so thats good.  I have other complicating factors that cause similar symptoms so at first I was blaming those but then finally realized it was the Escitalopram dose changes.  

 

It took me 3 months to stabilize when I dropped from 10 to 5, but then my Lyme issues flared which caused me to get back on the 10mg in January 2023.  Then I stayed at that dose until now.

 

Thank you for sharing your knowledge and time, much appreciated!

[manymoretodays]

Okay, and thanks for the reply UncleRay.

You'll see a link to that topic too, @Tulip52on crossing over from pill to liquid.  It's in my Monday post to UncleRay above, and I think Carmie explained it good too.  Some of us have had trouble switching to liquid, me being one, as I just switched to liquid and began tapering too fast way back when.......and really got into a mess of symptoms.  So a cross over, while making no drug dose changes is best......as far as harm reduction practices go.

 

@UncleRay, Do let us know how it's going.  I know it's not quite a week yet since you went back to 9 mg, with the liquid.......so maybe in a couple days?

[UncleRay]

Still holding at 9, will stay here a couple weeks.  It appears that the stronger withdraw symptoms have mostly settled, but not completely yet.  Any advice on how long to hold at 9mg?

[manymoretodays]

Your plan of a couple more weeks sounds real sound to me.

Know also that you could just do the next taper at 5%, rather than the whole 10% off the previous dose to test the waters, and see how that goes too.

 

9 mg present X .90= 8.1 mg or a 10% taper from present dose

9 mg present X .95= 8.6 mg or a 5% taper from present dose(rounding up from 8.55)

 

Glad to here that the stronger WD symptoms have mostly settled too!  Good going and news.

[UncleRay]

Is there a trend on whether the taper gets easier or harder the lower you get or do symptoms stay the same throughout each drop in dose?  Or as I'm guessing, its different for everyone?