TSRN: Depression has returned.. what now?

[TSRN]

I was prescribed Lexapro 10 years ago following the death of my daughter. I was started on 10 mg, eventually increased to 20mg due to anxiety issues. 3 months ago I decided that I wanted to stop taking this medication. I felt blunted most of the time, and wanted to see how I would do off of it. This was discussed with my family practitioner. We halved the dosage for a month and then halved it again for another month. At that point I was down to 5mg daily and doing ok. I then went to 5mg every other day x 2 weeks, and then stopped. I have been experiencing brain zaps and parasthesia daily. Its extremely uncomfortable and has made me withdraw from social activities. I force myself through the work day, then come home and get into bed. Last week I spoke to a Psychiatric NP and asked about Prozac as an adjunct to help with these symptoms. This is day 4 on Prozac 10mg which has helped maybe 20% with the head zaps. I'd appreciate input. This is miserable.

[Onmyway]

Hi @TSRN, 

you are suffering from withdrawal from lexapro. The best course of action in that case is to reinstate a small dose of lexapro rather than start a new drug. These drugs are from the same class but they are not fully interchangeable. We would recommend that you reinstate a small dose. Start with 1mg of lexapro and then if things get slightly better and not worse but not good enough, go up by small increments until you feel better. When you are in a tolerable place you can hold there and after a few months of stability can start lowering your dose further in a much slower way. 

 

It is common that people feel the effects of tapering at the lower doses. These drugs do not impact the brain in a linear way. 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

 

This video explain psych drug withdrawal very well. 

https://www.youtube.com/watch?v=PSjYH044-2Q

 

Can you please fill in your drug signature here so we can help you better, 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

OMW

 

[TSRN]

Thank you for this information. I'm encouraged to hear that what I'm experiencing isn't completely out of the ordinary. I plan on discussing the 10% taper with my Provider. Today has been a good day and I'm so thankful for that.

T

[ChessieCat]

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

Please weigh up your own situation with your prescriber.  The important thing is to be able to continue getting your prescription for the length of your taper.  Many medical professionals expect people to get off their drug in weeks/months, when in fact it can take years.  For me, I did a 6 year taper to get off 100mg Pristiq.  Some members don't tell their prescriber that they are tapering.

 

This is an excellent video, but please note that SA's taper rate is no more than 10% of current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug:

 

Antidepressant Withdrawal Syndrome and its Management

 

[TSRN]

I'm about 4 weeks out now from completely stopping Lexapro. The brain zaps are easing up but definitely not gone. Now I'm dealing with extreme fatigue and feeling basically nothing. I'm assuming this is part of the process too but would welcome input. I'd love to get back to the person I used to be - energetic, motivated, happy. Right now I'm more of a lump, mentally, physically and emotionally. 

T

[Onmyway]

Hi @TSRN

It might be a good idea for you to reinstate a small dose and taper from there at 10% a month?

 

For most people the zaps don't last very long. The other symptoms may go for longer, sometimes months and years. Reinstatement of a low dose (1-2 mg) and slow tapering is the best option to avoid the possibility of long term withdrawal if you have withdrawal symptoms. However reinstatement is done best soon after stopping.

 

Let me know if it's something you'd consider and I can then give you more info.

 

OMW 

[TSRN]

After meeting with a mental health nurse practitioner 2 months, I was started on 10mg of fluoxetine to help with the Less pro withdrawal. At that point I'd been off Lexapro for approximately 6 months and not feeling well. Very fatigued, disinterested, withdrawing from social interactions.  The fluoxetine isn't helping. I am experiencing severe anxiety, hypersensitivity to sounds, exhaustion. Its all I can do to get through a work day. At that point, I often feel like I want to curl up in a ball and scream. Literally. The frustrating thing is, I work in a behavioral health clinic and none of the practitioners seem to know about long term discontinuation syndrome. I can't keep going this way. To say I feel miserable is not even close to being accurate. I'd like additional information on restarting Lexapro with a slow taper. It sounds like this is the only way to manage without incredibly debilitating symptoms. 

Can anyone tell me about this? And has anyone got through this and actually had normal feelings again - joy, peace, excitement??

Thank you

[TSRN]

Its been almost a year since I started going off of Lexapro. The brain zaps continue, actually seem to be worsening. I haven't found a provider in my area who seems knowledgeable about protracted withdrawal symptoms. Is this normal? Is there anything I can do to relieve this?

[manymoretodays]

Here's your topic TSRN. @TSRN

How long on the Prozac with your last try mentioned in January with the 10 mg dosage?

Update your signature please.  Last update shows no meds since October 2022.

Just click here, and add in the most recent, and then click Save there when done:  Account Settings: Signature

 

More about: Brain Zaps (click on the underlined passage and start reading with the first post in topic there)

 

Here's the topic on:  About reinstating and stabilizing to reduce withdrawal symptoms

And this really is not applicable to "restarting" a drug that you liked, you'll notice the time frames and low doses mentioned here.

For example if you "reinstate" rather then "restart" with Lexapro now, you'll want to get a liquid, and only begin with 0.5 mg or less for the dose, 0.25 mg might be best, with a week or two of a patient try with it.  Keep notes or daily drug and symptom logs before beginning and then along the way.

Know your baseline.  And then if asking questions after a "reinstatement" type dose of Lexapro, you can post 24 hours clearly here for us to refer to.

Tips for tapering Lexapro(escitalopram) has more about escitalopram and the different forms it comes in, so you could do a dose as small as 0.25 mg

 

 

You have not had the success you wanted with a retry of Prozac now on 2 occasions, and so........I'd be wary on just trying any dose that is used for maintenance with Lexapro .  You've muddied the waters with 2 trials of Prozac now and may be subject to hypersensitivity or kindling(much more sensitive to Lexapro).

Hypersensitivity and Kindling

 

In the meantime, if you have not gotten started on Omega 3's yet........that is certainly an option that may help your journey to stabilization.

King of supplements: Omega-3 fatty acids(fish oil)

 

So.  Update your signature.  Look at the links. 

 

Let us know what you do.  Update right here, in your topic.

 

Best, L, P, H, and G,

mmt

 

 

 

[manymoretodays]

Thanks for updating your signature TSRN.

Although......I can't see why anyone would put you on Prozac(fluoxetine) 5 mg once a week.  That's a very odd reinstatement.

So you have 2 options for "reinstatement".

You could go back and try the Prozac at 5 mg daily........with patience and a strong hope that in a few weeks time, some of your WD symptoms are improved.

As far as dose equivalencies go, you'll see in this chart how Lexapro(escitalopram) is stacked, about twice as strong dose wise as fluoxetine.

Hayaska, 2015 dose equivalents of antidepressants

Plus escitalopram can be more activating for some than fluoxetine.

 

Again though if you do "reinstate" now with Lexapro(escitalopram) at 0.25 mg to start, you would want to take it daily, while keeping dailies, as mentioned above.  Same dose, same time of day, consistently.

It's the safest, harm reduction way to proceed.

 

You could also try citalopram(Celexa) at 0.5 mg for a reinstatement trial. 

 

Don't be shy.  I'm wondering if you reacted badly to Prozac.  Do tell.  If that was the case then I wouldn't reinstate escitalopram or citalopram myself.

You may have to use your coping like never before.

 

And yes, you are still in withdrawal, of a protracted type.  Are you having periods of time, windows at all?  Where you feel okay in a day, or for a couple days time?  Those are promising.

 

Thanks for the update.  Happy to give you more on WD. 

 

Post when you can.  Feel the the healing hugs.

 

L, P, H, and G,

mmt

Edited March 13, 2023 by manymoretodays
bolded

[TSRN]

Following up today on questions from Manymoretodays. And apologies in advance the lengthy response.

Initially when I went off Lexapro, it was suggested to me that Fluoxetine, due to its longer half-life might get me through the brain zaps. Although the Fluoxetine did ease some of the zaps when taken daily for the one week period, I ended up with horrible symptoms of anxiety, hypersensitivity to sounds, and more. So I stopped the daily Fluoxetine.

 

The extreme anxiety went away but the zaps continued. I forced myself to get through my work days but did little else. When the zaps became too distressing, I would take 1 Fluoxetine (which was dumb) but I liken it to taking Tylenol for a headache even though it doesn't do much - you just hope it will because you're feeling miserable.

 

In January 2023 I had a 72 hour EEG done which showed some intermittent spiking (no actual seizure activity) but, per the neurologist, possible pre-seizure spikes. The doctors don't have a solid answer regarding the zaps or what the EEG results mean for sure. I was offered the option of trying an anti-seizure medication, but declined at that time. Again, hoping the zaps would ease up. They have not. They've increased. 

 

In addition, I started phantom smells that I've experienced prior to SSRI discontinuation (ENT issues were ruled out) have also increased in frequency and duration.

 

I returned to the neurologist for follow up today. I brought up protracted withdrawal which doesn't seem to be well understood. I'm scheduled for an MRI in April and was encouraged to try Keppra (ant-seizure med) at a low dose of 250mg daily. I have not picked up the prescription and after reading about the more common side effects, am really hesitant. On the other hand, these zaps are making my life miserable. They increase in the evenings, when I'm entering a relaxed state and as I'm tryingto go to sleep. I've even woke up feeling them occur. They just won't stop.

 

My psychiatric provider has been on maternity leave so I haven't been able to talk to her about trying a very low dose of lexapro with the recommended 10% reduction taper but plan on doing so when she returns in a few weeks.

I cannot imagine having to tolerate these symptoms for the rest of my life.

Thank you for reading and any responses you may have the time to provide.

 

Edited March 25, 2023 by manymoretodays
just spacing for readability

[manymoretodays]

Hi TSRN,

It occurs to me that your initial reinstatement of Prozac may have been too high, as those brain zaps set in.

That 10 mg.

As you review the reinstatement topic you'll see.......we usually don't reinstate high, we just want enough to help with withdrawal and symptoms.

So......what you could do is do another trial, of daily Prozac.......do one week at 1 mg taken at the same time every day, and if no change with the zaps and no increases in anxiety or hypersensitivites, then the next week you could try 2 mg daily.......holding for the entire week and doing some daily drug and symptom logs, for you, and then if needed you can share some with us.

Tips for tapering off Prozac(fluoxetine) should have everything you need to know to get a dose that isn't the usual prescribed dose, so you can start low and observe, before increasing at all. 

This is the kind of daily log that is helpful when someone does a small reinstatement:

Recording drug schedule and symptoms to track patterns and progress

Looking at the before you take your drug and after and then symptoms as they occur throughout the day. 

 

And I would think that even with a small reinstatement of Prozac, that due to it's long half life it could take a whole week to hit a nice low steady state to see if it does anything on the positive side.  So if it was me and I tried it.......I'd just hold steady with the 1 mg unless you start sensing a stronger unease or anxiety coming on again.  And then once again, hold for a whole week if you get to 2 mg daily at the same time of day.

I would love to see a lower dose improve your zaps, but I just don't know for sure if it will.

 

And so leaving it up to you, if you'd like to experiment this way.

 

Brain zaps- more on these, and maybe you could print off any articles there, and then note take too.......so you can share with the neurologist, as to the reality of these occurring and withdrawing from a drug like yours.

Brain zaps

 

On 3/12/2023 at 12:09 PM, manymoretodays said:

In the meantime, if you have not gotten started on Omega 3's yet........that is certainly an option that may help your journey to stabilization.

King of supplements: Omega-3 fatty acids(fish oil)

 

Have you started on any Omega 3, fish oil yet?  That's another that might help with the zaps.  I don't know exacty why and it could take some time too, but certainly worth it.  Start low and slowly build up in dosage.  Most, including me, will split the dose......I do morning and evening, so just twice a day, and keep mine in the freezer so I don't get gassy from them.....or "fish oil farts".....which did seem annoying when I did not do them frozen. 

Happenstance and a lovely other member recommend led me to using Barlean's (pharmaceutical grade, ultrapurified, fresh catch).

You have to look at the labels and add up the EPA plus DHA and see how many capsules that is in.  Mine is 600 mg of EPA+ DHA in 2 capsules, and then there is another unknown of ....."other omega-3 fatty acids" listed at 80 mg and so 680 mg in 2 capsules I figure, and I take 6 capsules a day now split up to get 2040 mg then daily.  On the lower side but way back when I first tried some, while still on drugs-medications, I found 3000 mg to be too much......I bruised easily.  Look at the link, and you might find something doable from Costco too, they have online ordering as well........and so then just start with the minimum and go up every few days until you get to the best dose for you.

 

I do hate to have you try 2 things at once though.  And here is why on that:

If you have Prozac available now, and can do some liquification of it, and get it measured up into 1 mg daily doses...........I might try that first.  Go with it for a week and if no real worsening of anxiety or anything, go with 2 mg for a week.  And maybe......in 2 weeks time........zaps improved.  Wouldn't that be cool.  And then you just maintain on that for awhile, and when ready taper it, 10% of each previous dose with a nice 4 week interval before going further.

 

Then you could....... once settled on a dose,  try the Omega-3's too, gradually increasing until you get up around 3000 mg daily of them.

While being your own little scientist too, with daily drug and symptom logs....

 

Really up to you, if you want to get going with Omega-3's first.......do that and once you've settled in on a decent dose size.......you could trial 1 mg Prozac to start.

 

You might even be able to push your next neurology appointment until later too...........if it's early in April you won't have your trial and data completed yet.  Do you follow?  It would be most satisfying to see some change in that EEG I would think, if you achieve a lowered subjective feeling of the zaps. 

 

Okay.  Keep us updated.....please.  You otherwise sound to be managing well TSRN.......proud of you.

 

Love, peace, healing, and growth,

mmt

[TSRN]

Back again... sounds like a Slim Shady verse. Anyway, to catch up on what's happened since my last post.

* I started taking magnesium glycinate 360mg , Omega-3 fish oil (2 capsules - total 2000mg fish oil, 1500mg total omega-3 acids, 800mg epa, 600mg dha), and a B-complex at bedtime, beginning in early April 2023.

After being on this regimen for about a month, the 'zaps' seemed to ease. They went from an intense buzzing that I could actually feel, to a more subdued sensation. I thought this was it! This is my answer! I even had a period of about 1 week in late May when I went 3 or 4 nights with no zaps at all.

Several weeks ago, the zaps increased in intensity and frequency again. These mainly occur as my body is relaxing and getting ready for sleep. The sensation instantly sends me back to fully awake mode. I'm really tired... 

I see Neurology again next Friday (6/23/23). 

Manymoretoday I greatly appreciate all of the suggestions you've provided. I have not added anything back in, as far as antidepressants go. When discussing protracted withdrawal and the idea of micro-dosing, none of the providers I've talked to seem to be aware that this is even a thing. The only conversations I've had regarding the possibility of protracted withdrawal, has been on this board. Providers here seem to think that these symptoms never last longer than a couple of weeks..... if only.

 

 

2011-2012 Lexapro 10mg

2012-2022 Lexapro 20mg

March 2022-June 2022 Tapered by half each month 

June 2022 - Stopped Lexapro completely 

Last week of June 2022 - Prozac 10mg x 5 days

Aug 2022 - Jan 2023 Prozac 5mg once a week

[TSRN]

I've been off of antidepressants completely since January 2023. Brain zaps still occurring with less frequency and less intensity - mainly at night. Unfortunately my mood has declined. Multiple stressor including the recent loss of my father, assisting my mother and working full time in healthcare. No joy, no emotions other than irritability and hopelessness. It's a push to get through the day. I’ve been fighting it but its slowly getting worse. I spoke to my provider honestly about my mood and the PTSD from protracted withdrawal.. trying to weigh out what to do. Has anyone else experienced the return of depression?  What have you tried? I see a therapist weekly. Try to push myself to get outside but most days I'm just exhausted. After much discussion I agreed to try bupropion. 2 days of intense anxiety and inner restlessness. I won't be trying for a 3rd day. But what now? I don't want to feel like crap for the rest of my life. Any suggestions? 

 

 

 

2011-2012 Lexapro 10mg

2012-2022 Lexapro 20mg

March 2022-June 2022 Tapered by half each month 

June 2022 - Stopped Lexapro completely 

Last week of June 2022 - Prozac 10mg x 5 days

Aug 2022 - Jan 2023 Prozac 5mg once a week

Bupropion 150 XL March 12 and 13, 2024. Quitting it as of yoday.