Friendo: escitalopram withdrawal, severe appetite/weight loss and nausea - considering reinstating

[Friendo]

Hi all,

 

Thank you for this community. I'm glad I found it. I am a 26-year-old male. I was on 10 mg of escitalopram for anxiety for about 6 years and decided to taper off at the start of this April. My plan was to cut to 5 mg for a month, then 2.5 for another month. In my mind, this was a conservative taper because I'd come off citalopram at a higher dose many years before, and that taper was much more rapid.

 

About two weeks in on 5 mg, I didn't experience any issues and honestly felt better than ever emotionally and anxiety-wise. The only difference I noted (though I didn't make the connection to escitalopram) was that my weight had dropped from its usual spot at 136-137 lbs (I'm 5'8"), down to 131 lbs. I noticed this when they weighed me at the doctor's office, but I didn't think too much about it at the time because my weight tends to fluctuate seasonally.

 

By the end of the first month, I was about 129 lbs and starting to suspect something was up, but I had still not made the connection. I noticed my appetite was lower and wrote elsewhere, "I'm losing maybe too much weight... The weird thing is, I don't feel hungry; I eat till I'm full and am always satiated, despite apparently not getting enough calories." I chalked this up to dietary changes (I had gone low-carb in January/February, before tapering), and added in more carbs to my diet to compensate.

 

Around this time, my family started to comment that I was getting very thin (and I was already thin before), and I agreed but could not figure out why this was happening. Adjusting my diet didn't seem to help, and I continued losing weight.

 

By the time the second month rolled around (2.5 mg), I had dropped to 125-126 lbs. Amazingly, I still had not connected this to the tapering because I had no other typical withdrawal symptoms yet. I started getting frustrated and tried to eat as much as I could tolerate with my reduced appetite, 3 meals a day, but it still wasn't enough to regain weight. I was maintaining, but with a lot of effort.

 

A month later (June), I finally quit escitalopram. It wasn't till this point that the classic withdrawal symptoms appeared. Within days, I developed brain zaps, nightmares, anxiety, and sensitivity to sound. I also developed nausea and gagging/dry-heaving when eating or thinking about food. At last, I made the connection, but every story I read online said that the nausea and reduced appetite returned to normal 2-3 weeks after quitting.

 

This has not been the case for me. The other symptoms passed, but as of July, over a month after quitting, my only remaining symptoms are the nausea and appetite loss, and I can't say they've improved at all. I don't have that automatic "drive" to eat anymore; I have to remind myself, and even then I eat very slowly (to avoid gagging) and can't finish meals that I used to be able to. I currently stand at about 123 lbs (on the cusp of being underweight) -- I have lost roughly 13 lbs during this whole process. I'm a little terrified, to be honest.

 

My questions are, is it a good idea to reinstate at either 2.5 mg or 5 mg? Should I attempt to even though it's been over a month? Does anyone have advice to get my appetite working again or reduce the nausea?

[Friendo]

July 12: Continued inability to eat very much. Started to drink chocolate Ensure but similarly finding it hard to take. Weight as of this morning is 122 lbs.

[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.  It sounds like you tapered off the Lexapro a lot faster than your brain was able to adjust, and hence you developed withdrawal symptoms.  We suggest a taper rate of 10% reduction per month, the 10% being based on the current dose.  Nausea and lack of appetite is a common symptom of withdrawal.  I can understand why you are concerned about this.  The good news is, this should eventually abate, and perhaps a temporary reinstatement will help too.  More on that later. 

 

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

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and 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: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

These 2 links will give you some ideas to help you with your nausea.  

 

What to Do for Nausea, Queasiness

 

Digestive Problems

 

 

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

 

Finally, going back on a small dose of your drug, which we call reinstatement, is best done very carefully.  This is temporary, and after stabilizing you would then taper gradually off of this.  There is some risk involved, and we need more specifics about your drug history before we can suggest a good dose at which to reinstate.  Please don't reinstate yet, as doing it incorrectly can cause big problems.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

Edited July 12, 2022 by getofflex

[Kostas]

Hi ,

First of all ,I don't think you are underweight!

Εven now ,your bmi according to your data, is I think around 21 which is fine..

Did you gain any weight beeing on the drug ,from your historical weight ?

In my case ,being on citalopram I came from 70 kg to 77  ,and when stopped it ,gradually went back to 71 and then to 74 where stabilize. 

My appetite was quite low during withdrawal, but forced to eat small meals quite often. 

Back to normal appetite, 6 to 8 months...

 

[Friendo]

1 hour ago, Kostas said:

Hi ,

First of all ,I don't think you are underweight!

Εven now ,your bmi according to your data, is I think around 21 which is fine..

Did you gain any weight beeing on the drug ,from your historical weight ?

In my case ,being on citalopram I came from 70 kg to 77  ,and when stopped it ,gradually went back to 71 and then to 74 where stabilize. 

My appetite was quite low during withdrawal, but forced to eat small meals quite often. 

Back to normal appetite, 6 to 8 months...

 

Hi @Kostas, my BMI is 18.5, which is underweight. It was 21 back before I started losing weight.

 

I gained about 5 lbs when I first started escitalopram: 130 -> 135 lbs. But now I am 122 and haven't weighed this little since I was maybe 14 years old.

 

It's good to hear that your appetite stabilized eventually!

[Friendo]

5 hours ago, getofflex said:

Finally, going back on a small dose of your drug, which we call reinstatement, is best done very carefully.  This is temporary, and after stabilizing you would then taper gradually off of this.  There is some risk involved, and we need more specifics about your drug history before we can suggest a good dose at which to reinstate.  Please don't reinstate yet, as doing it incorrectly can cause big problems.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through.  Please know that the brain is amazing in it's healing abilities.  It takes time, but healing can and will happen. 

 

Updated my signature with medication and supplement history. Is this enough information to talk about reinstatement?

[getofflex]

I would suggest trying a reinstatement of 0.5 mg of Lexapro.  Lexapro is an extremely powerful drug, and reinstating too high can kindle your nervous system, and make things even worse.  We can start out with 0.5 mg, and if you need more, gradually and carefully go up from there.  Give the 0.5 reinstatement at least a week, as it takes that long to fully get into your system and register with your brain.  If you feel significantly worse after you reinstate, stop immediately.  

 

The easiest way to do this is to buy a commercial liquid, or make you own liquid using your tablets.  This link explains more about that: 

 

Dosing and Tapering Lexapro

 

Please keep us posted, and let us know how it goes.