AGlassDarkly: hello fellow travellers!

[AGlassDarkly]

Hello!

A quick glance at my signature shows that I have been dancing a reluctant jig with SSRIs for over thirty years. I have continued to battle my low mood and and hopelessness during this time, but with little relief – and certainly not from the SSRIs! Now four months into a complete cessation from any SSRIs I am [of course] going through the mill of WD with my brain struggling to re-establish homeostasis. My personal list of 'goodies' include: Despair, anxiety, anhedonia, depersonalisation, derealisation, constant 'fight-or-flight' response, insomnia. 

 

In thirty years (apart from the odd few nights during starting/altering doses of SSRIs) I've never suffered from poor sleep like I am now! So I'm wondering  should I re-instate my last drug, Escitalopram (Lexapro) in a small dose (?), and begin to taper the proper way this time – or should I just ride it out? Should I even expect that doing this will correct my sleep pattern? 

 

 

Many thanks for reading.

[Altostrata]

Welcome, @AGlassDarkly

 

First, congratulations for what must have taken considerable willpower in getting off your drugs. 

 

However, a fast taper and skipping doses can be wearing on the nervous system. If you are finding the withdrawal symptoms too harsh, you might want to try a reinstatement of perhaps 1mg escitalopram. We have seen even that small amount may ameliorate withdrawal symptoms. You'd stabilize, then taper off by minuscule amounts later. 

 

A liquid form is the best way to take this very low dose. See Tips for tapering off escitalopram (Lexapro) for information.

[AGlassDarkly]

Thank you @Altostrata for the welcome – and advice about the 1mg escitalopram. I think before I do that I will try a starter supplement of 25mg magnesium. It sounds like this has helped a lot of sufferers! I'll report back any benefits as/if/when they occur. 

[Onmyway]

Hi @AGlassDarkly

Just have in mind that the window for reinstatement is not very long. The longer you go without your drugs the harder it may be to reinstate. You might have worse symptoms from going back or they might not work at all. While we do recommend magnesium (oxide can be tough on your tummy) reinstatement is the one way that is most likely to work. Reinstatement doesn't mean that you're weak or not though enough. It just means that your brain needs time to adjust more slowly.

 

I reinstated at 2.5mg of citalopram (before I got to SA) and it did help. If it doesn't you can stop in a few days.

 

OMW 

[AGlassDarkly]

Hi @Onmyway

Thank you for your advice. Without actually testing, I guess it's hard to know exactly how long the "not very long" reinstatement window might be. I suspect it may be individual to each case. 

18 hours ago, Onmyway said:

If it doesn't you can stop in a few days.

 Stop as in cold-turkey stop – or taper stop? :0

[ChessieCat]

Please read Post #1 of this topic:

 

About reinstating and stabilizing to reduce withdrawal symptoms

[Onmyway]

39 minutes ago, AGlassDarkly said:

Hi @Onmyway

Thank you for your advice. Without actually testing, I guess it's hard to know exactly how long the "not very long" reinstatement window might be. I suspect it may be individual to each case. 

 Stop as in cold-turkey stop – or taper stop? :0

@AGlassDarkly

You're right - these are individual. Some people can reinstate in months but the hard won wisdom from many cases here is that the longer the wait, the harder the reinstatement as your brain has made changes. We consider 1-2 months to be the window. Someone did do an excel sheet with the info on reinstatement from many cases - you can look for the thread. And to be fair reinstatement doesn't always work either. So it's up to you and your tolerance for risk in either direction.

[AGlassDarkly]

@Onmyway Many thanks. That's useful info to have. I'll certainly do a search to find that excel sheet graph.

[AGlassDarkly]

Have been taking Magnesium citrate 50mg (spread over two daily doses) for the last week. I haven't noticed any effects – positive or negative [yet]. Is it worth adjusting the dose I wonder, or does it just 'not work' for some people? 

My GP (in UK) is not allowed to prescribe me Melatonin under the NHS, so I drew a blank there. He also wasn't keen to offer me 'proper' sleeping pills – which I actually thought was sensible! He did point me in the direction of a CBT-based app called Sleepio which I'm looking into. Anyone experience of that here?

I mentioned a test reinstatement of Escitalopram to him. I don't think he was convinced, but did write me a prescription for 15mg of the liquid (very expensive I was told!) which I have subsequently cancelled. I've decided that after nearly five months drug-free I really don't feel any appetite to start all over again – no matter how small the dose. I also don't think I can manage the minutiae of tapering an ever more minuscule dose without it driving me [more] crazy!

Sleep patterns seem really disturbed now though! It's as if my body tries everything in its power to stop me falling asleep. I can often feel my body waking me up just seconds after I have finally dropped off. Very debilitating self-sabotage! Crazy dreams as well, which I remember well is the hallmark of the early weeks of beginning an SSRI. I wonder whether that's a clear sign that these effects are related to a trace residue of the chemical – or merely the results of my brain wiring being re-routed, so to speak. Who knows I guess…? Anyway, onwards!

[Momiki]

Hi AGlass Darkly,

 

Your writing style put a smile on my face.

 

I think 50 mg of magnesium isn't that high. I've had times where I've taken 400 mg a day. I might also be one of the people for whom it doesn't work. I don't notice much effect either. Anyway, here is the topic on magnesium with more info. Perhaps different forms of magnesium give you better results (I haven't tried):

https://www.survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

There is also a topic on sleeping problems, did you come across that one already? Link is as follows:

https://www.survivingantidepressants.org/topic/25270-tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia/

 

The other recommended supplement is omega-3. Perhaps worth a try, if you haven't already?

 

 

[Altostrata]

4 hours ago, AGlassDarkly said:

Have been taking Magnesium citrate 50mg (spread over two daily doses) for the last week.

 

100mg per day is very little. You might try taking 50mg 4 times a day.

 

How has your symptom pattern changed in the last month?

 

See

 

 

What is the sleep cycle?

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

White noise devices for sleep

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

Strange sensations while falling asleep -- surges, zaps, jerks

 

Hypnic / hypnagogic jerks when falling asleep

 

[AGlassDarkly]

@Momiki Thank you!

@Altostrata Dosage advice noted with thanks. I don't have a cast-iron digestion so I guess I'll have to updose carefully – just until the point where my bowel complains!

Symptom-wise, as I enter my fifth month off the meds I'd say that the dark dp/dr days seem to be behind me now (I hope!), anxiety seem manageable (the mindfulness meditation helps here). However, the difficulty falling, and maintaining sleep feels like it's starting to be an ingrained habit at present.
 

I've discovered that there are quite a few so-called 'pharmacies' online willing to supply Circadin (Melatonin) in the UK … Just saying. 🙄

[AGlassDarkly]

I allowed myself an ironic chortle this morning. I've been so preoccupied dealing with these awful wd symptoms from anti-depressants, that I haven't really been bothered by my underlying depression! 😏

[Momiki]

Well, laughter is said to be the best medicine, so you're taking good care of yourself.

[Onmyway]

3 hours ago, AGlassDarkly said:

I allowed myself an ironic chortle this morning. I've been so preoccupied dealing with these awful wd symptoms from anti-depressants, that I haven't really been bothered by my underlying depression! 😏

I've found that the depth of depression and the intensity of anxiety of withdrawal were so high for me that the anxiety for which I went on these drugs seemed almost laughable compared!

 

[AGlassDarkly]

I've upped my daily dose of Magnesium Citrate to 200mg last few days. Not noticing any real effect on sleep one way or the other so far…

 

I've also managed to 'acquire'   🤭  some Melatonin. 3mg of normal release I believe. I took half a pill (1.5mg) about an hour before bed last night. I'd say its effect was very subtle in producing a mild drowsiness – which I managed to use to my advantage and get a few precious hours of zzz. It's much more subtle when compared to my occasional use of Nytol/Sleepeeze – which feels a bit like the lights suddenly go out in your head and you wake feeling muzzy and drained. 

 

Two Qs for you seasoned users: 

– Should I continue using this 1.5mg dose every night for awhile to aid the 'reset' – or every few nights/occasionally?

– Should I stop taking the Magnesium considering my poor results with it? Is it even safe to take alongside Melatonin?

 

Thanks!

 

[Altostrata]

13 hours ago, AGlassDarkly said:

I took half a pill (1.5mg) about an hour before bed last night. I'd say its effect was very subtle in producing a mild drowsiness

 

This is the usual beneficial effect of melatonin. You might get the same effect from 1/4 of a tablet (0.75mg) or even less.

[AGlassDarkly]

Many thanks Altostrata. Very useful to know. I'll certainly give that a go. It'd certainly save me some £s, and I'd be happier taking less – always!

 

I'd be interested to hear from anyone in the UK whose GP is in an NHS area that allow the prescription of Melatonin for insomnia. My GP (in Oxfordshire) told me that his area was only allowed to prescribe it for something like 'emotional learning difficulties in young people.' It seems there is some inconsistency across the NHS re Melatonin. 

 

[Altostrata]

The NHS restrictions on melatonin are absurd.

[AGlassDarkly]

On 9/15/2022 at 11:09 PM, Altostrata said:

You might get the same effect from 1/4 of a tablet (0.75mg) or even less.

@Altostrata Thank you! You were right. 1/4 tablet seemed to produce a very similar effect in me last night. Look how much money you've saved the NHS…! 🤑

[AGlassDarkly]

Just posting a quick update for the record… First the positive:

 

1/4 (0.75mg) tablet of Melatonin nightly seems to be consistently helping with my PAWS insomnia. I don't want to become enslaved to the new substance, so I take the occasional night without it – which seems doable, at least. 

 

Now the downer:

 

Into my fifth month totally med-free and the anhedonia aka 'emotional anaesthesia' has bitten deep and hard. What an unwelcome guest it is… 😩 It's so unlike anything I experienced previously as a symptom of depression. I guess the severity and character of these symptoms is a clue that it is related to recovery from the meds – and the re-wiring that's going on 'upstairs'… 

 

It feels like trying to push a stationery car while the handbrake is on. 

 

All things must pass…

[Altostrata]

Are you getting more sleep now?

 

Melatonin does not incur dependency. Are you able to get more melatonin?

 

Emotional anesthesia can be very disturbing. Hang in there, it goes away with time. Exercise helps. Are you getting at least 1/2 hour of gentle exercise per day?

[AGlassDarkly]

@Altostrata Thank you. I get much less sleep than I used to, but what there is of it seems to be stabilising into a reliable pattern. I'm grateful for that.

 

Reassuring to know Melatonin does not incur dependency. I managed to talk my NHS GP into giving me a Melatonin prescription, after I provided him with some online information from NHS, NICE and the BNF websites. So relieved I no longer have to rely on online 'pharmacies' for my fix. 

 

I consider myself a pretty stoical chap, but this emotional anaesthesia is giving me a run for my money. 😣 Walking is my exercise, about 50mins – morning and evening. Without it I'd be sunk. 

 

Thank you for your support and all you've accomplished with this place. 🙂

 

[AGlassDarkly]

It struck me later today as I was interrogating 'emotional anaesthesia' and the precise nature of this bout of my symptoms, that what I am currently experiencing is actually more like what I might call perverse emotional blunting or maybe selective emotional response,. e.g. I realise that I am actually feeling some very intense emotions! – but they'll be aimed at total strangers in the street, animals, trees etc. If fact it seems to include anyone who isn't nearest and dearest – like partners and family. Isn't that truly perverse? And very hard on them. 😔

 

At one point today I felt as if I was channeling the suffering of the world – or at least my city. I'm sorry – it sounds so grand and silly! But it made me realise that what I have been describing as 'emotional anaesthesia' or blunting wasn't quite accurate enough for my own flavour of chemical misery-of-the-day. 

[Altostrata]

Interesting. Are you feeling intense positive emotions sporadically? Please explain more.

[AGlassDarkly]

@Altostrata I'd say that the positive emotions are certainly experienced sporadically – and that empathy is the emotion most strongly felt. But perversely so, in that it seems directed randomly – and not towards those one might expect. As per my previous comment re 'channelling the suffering of the world', the result is an intense wave of pain, so in that way maybe it shouldn't be labelled positive? But for the large part, pretty well anything I used to find joy in has currently vapourised. That's much more text-book anhedonia I'd say.

 

One possibly related experience that I should record here is that over the past year of tapering I have on three occasions experienced a fleeting feeling of complete relief from any symptoms of misery, depression or electro-chemical interference. I was calm, at-one, still, and free of all anxiety. It was like that moment when a nasal decongestant works its magic and one can suddenly breathe again. There seemed no link with external influences or surroundings. The onset was sudden, and the longest duration was about 3 minutes. The feeling gradually drained away after that. Like a window being opened on a completely beautiful day – then firmly closed again. Extraordinary. The second time it happened (possibly three or four months later) I was able to bask in it and examine the state more carefully – but unfortunately all subsequent 'bliss moments' have been much shorter (2mins or so). 

 

I'm sure I've read somewhere about the chemical released by the brain during our dying moments (I believe also that this is released also during our birth moments). Does this have a factual basis, or have I dreamed it? Anyway, my bliss moments called this phenomena to mind. These were certainly grounded moments – not trippy. For the record, bar the very occasional spliff – and one episode of magic mushrooms – all long ago in my twenties, I have not experimented with hallucinogenics. Not that I'm judging anyone who has/does you understand. 🙂

 

Sorry for the long post – but you did ask. 😉

 

[Altostrata]

We might interpret this as your nervous system sometimes attaining the stability it's working towards. See The Windows and Waves Pattern of Stabilization

 

[AGlassDarkly]

For the record: Coming up to 1 year off Wellbutrin, and 6 months off Escitalopram. 

 

Sleep: Patterns seem to have stabilised at around 5-6 hours of 'good quality'. I continue to take 1/4 (0.75mg) tablet of Melatonin half-hour before a 10pm bedtime.  However, whilst initially my sleep problems were getting-off to sleep – now this has reversed, and I now wake earlier (4am-ish) and more abruptly: the cortisol response maybe? Then I'm not really 'sleeping' more after that…

 

Mood: Seems to be following the classic, waves and windows scatter-gun pattern – no strong trend toward either one or other yet.

 

Anhedonia is by far the single biggest challenge I'm currently facing. I've simply lost the ability to want to engage with anything that used to bring me relief, give meaning, or characterise my existence! Right now I'm lucky to have a small private pension that I can draw on to get me through financially, as all my careers have died. I've withdrawn from the world and the world (quite understandably) has withdrawn from me. 

 

As I look back over the past ten years I can see a steady slipping away of all the areas of my life that I feel defined me: Music-making and teaching, graphic design work, photography and film-making. I don't recognise the person I was then – with what I see now. I feel like a shadow, or a mirage! To lay all the blame on the medication is probably unfair – but I do wonder what a totally un-medicated version of myself might have achieved!

 

The latest casualty is books. I've been a voracious reader my entire life – but in the last couple of months I find that I'm deliberately avoiding any books. I'm wondering whether it's because I'm trying to avoid excessive mental stimulation during this healing phase…? Possibly. 

 

I'm hoping I can eventually pick up the pieces and stick them back together. In time for my sixtieth birthday (two years away) would be nice…

 

Anyway, peace and strength to all of you out there on the lonely road! 

[itiscomplicated]

33 minutes ago, AGlassDarkly said:

I feel like a shadow, or a mirage! To lay all the blame on the medication is probably unfair – but I do wonder what a totally un-medicated version of myself might have achieved!

 

I think that as time goes on being off the drugs, many of us experience a return to emotional and other problems that we dealt with with medication, in addition to the withdrawal effects. It can be overwhelming and confusing, all of it together, and sometimes hard to tell what's "you" and what's withdrawal.

 

Don't be hard on yourself, though. It sounds like you've achieved a lot, and right now you're looking out for your health.

 

Best wishes for a continuing recovery!

[AGlassDarkly]

43 minutes ago, itiscomplicated said:

a return to emotional and other problems that we dealt with with medication, in addition to the withdrawal effects.

@itiscomplicated Excellent point. Thanks for highlighting. Also, many of the issues that once were masked by the meds we now have to return to in a 'sober' state – and face! Congrats on your six-month off milestone btw…

Edited November 17, 2022 by AGlassDarkly
Clarification.

[AGlassDarkly]

Updating the record:

 

Took a massive downward hit over Christmas (surprise, surprise!) with a wave that continues to break. The better sleep patterns established in my last updates have been disrupted again, with my regular dose of Melatonin not appearing to help. Strange GI stuff going on as well – return of Airway Reflux (LPR) from years ago. Anhedonia turned up to 11… Episodes of depersonalisation showing up again – unwelcome reminders of that awful heatwave [in the UK] of last year.

 

However. I checked in here today and found this very practical and comforting list created by @Scrountz A ten step guide especially useful for those who have been hit hard by Cold-Turkey or less-than-optimum tapers and are continuing to suffer long after the pills are gone. It really helped me get a grip today! Thank you @Scrountz 👍

 

 

 

[Momiki]

I'm sorry to hear your symptoms have gotten a lot worse, AGlassDarkly. I hope you'll feel better soon!

 

Thanks for sharing the link! My symptoms aren't that bad compared to others on this forum, but I find the information useful nonetheless.

[AGlassDarkly]

PS I also feel as though once well-tolerated natural supplements such as Vits C, D3, and Magnesium are having a disruptive, unwanted energising effect on my CNS at this stage of my repair journey. 

 

Is this similar to anyone else's experience? 

[AGlassDarkly]

Separating out what constitutes depression and despair from withdrawal/withdrawn symptoms is an ongoing challenge. I've found that friends and GPs might have some degree of sympathy during the actual acute withdrawal process, but as the months without the substance pass, this can wane. Surely what the return of the low mood is indicating is that you require your medication to function, they ask? It's a fair question I suppose. 

 

When I faced this over the weekend, I suddenly realised that as I look back over forty years of depression (some better/worse years than others) the one thing I could always rely on was my sleep. It was my only escape – the only rock solid dependable way of turning off my over-active mind for a repair session. 

 

I reminded myself that though I might well be experiencing a return of low mood – the current destruction of my sleep patterns are med related – NOT depression related. It's seems obvious really, but reminding myself of this today gives me a boost to press on with the repair process drug-free – and not to go running back to any medication as being the answer just because well-meaning GPs and family pressure us to do so. 

 

Your mileage may vary – of course… 😉

 

[AGlassDarkly]

I'm now eighteen months off Wellbutrin, and one year off Escitalopram – As if my mind gives a damn what the date is…!

No major changes to report. The life-sapping anhedonia seems a permanent fixture. Sleep remains disrupted, but the pattern has switched from wired-hours trying to fall asleep to wired jolt-like awakening at 4am and not being able to return to sleep. I've imagined the switch as maybe my brain finishing wallpapering half the room – and now it's beginning work on the remainder.

I'd almost trade these sleep woes for a couple of mg of Escitalopram… just for the hell of it. Almost. 

[Momiki]

Congratulations on the off-meds-anniversaries! I'm sorry to hear there's no improvement in your WD symptoms yet. We know from this forum that eventually improvement will come, but it's tough to sit it out, not knowing when things will improve. Hoping you'll have a lot of windows soon! 🤞