Mattie: tapering off Pristiq

[getofflex]

Your welcome!  I spent some time in the book yesterday, working on an exercise to correct faulty ways of thinking about a particular issue in my life.  Definitely helpful for me!  Yes, negative thoughts about being this way permanently are depressing.  Please read this link carefully.  Many of us in WD think we will be this way all the time, it a mean trick our WD brain plays on us.  The info in this link addresses that. 

 

Techniques for Managing Withdrawal

 

 

[Mattie]

Thanks, I’ll read the info you shared and I’m ordering book today 

[getofflex]

Try not to get overwhelmed by the sheer size of the book, almost 700 pages.  I would just read the introductory chapters, and then the chapter on depression and do those exercises.  They are simple and easy to do.  

[Mattie]

Ok will do, thanks for that tip. And also you mentioned in another post about developing a spiritual life to help with depression and yes I’m very spiritual and it has truly carried me through this trial thus far, thanks again 

[Mattie]

It was suggested to me a long hold. Could you please tell me what is considered a long hold? It’s been 81 days since I up dosed after making a drop from 5mg to 4.8 for 20 days and up dosing back to 5mg . I’m still in the thick of it and still feel worse mentally than I did before the switch. I realize I was not stabilized when i made the switch because I was still having windows and waves but felt significantly better than now. A lot of fear that improvement will never come. How can such a tiny drop and updose affect me this much. I feel so hopeless. If I knew eventually I would stabilize, I could better carry on. Thanks for your time 

[getofflex]

We suggest you listen to your body, and wait until you feel stable.  This link will explain what we mean by stability.  

 

Stability

 

You say you are feeling worse mentally. Does this mean your physical symptoms have improved?  

 

We may need to consider the possibility that you are having an adverse reaction to the Lexapro.  How do you feel in the 4-5 hours after you take it? Overall, do you feel better, or worse, or the same?  I suggest you try doing a daily drug and symptom journal.  

 

Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug. Please do this for 24 hours, and post an entry in here for each 24 hour period.  Here is an example: 

 

January 31, 2023

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

 

 

[Mattie]

You asked if some of my physical symptoms have improved. Yes to a degree. The first month and 1/2 of drop/updose I had completely lost my appetite I lost 13 1bs in 20 days. My appetite has since returned. The first month and 1/2 I was sleeping at least 10 hrs a day and wake up so exhausted that I couldn’t get off the couch all day. Couldn’t bathe, function, flu like symptoms. Now I’m still exhausted upon awakening but I can function more, sit outside in sun , take short walks, do a very little house necessities due to lack of motivation. I still have to struggle but at least I’m not couch bound anymore. The first month 1/2 I would have early morning awakening with anxiety, hurting in gut etc . That had completely went away but the last few days it has returned and the last few days I feel more exhausted and zero motivation. My low mood and crying spells never went away. I’m still having windows of sorts daily in the early evening but they are not nearly like the windows I had before I made the drop/updose . Over all I’m doing better than the beginning but still feel horrible and no where near how I felt before I dropped. Life is a struggle every day. I will do what you suggested and make a daily symptom list and post it when I’m done. Thanks again for all your help!!

[getofflex]

6 hours ago, Mattie said:

Over all I’m doing better than the beginning but still feel horrible and no where near how I felt before I dropped.

This is good news, that you are doing better overall, even though you are still not as good as before the reduction.  I'm sorry that dropping from 5.0 to 4.8 was so destabilizing.  I see that you bridged over from Pristiq to Lexapro a year ago.  It is likely that this bridge destabilized you, and you were not yet ready to start tapering the Lexapro.  And, you've had many, many drug changes since 2020, including a cold turkey of Prozac, all of which are destabilizing to your nervous system. It would be very beneficial to give yourself a very long time on the 5 mg of Lexapro, before attempting any tapering or any other drug changes.  If it were me, I would wait a year or two to really give my brain a rest, and allow it to completely stabilize.  I believe if you do this, you will have a much easier time tapering off in the future.  

 

Are you completely avoiding alcohol and other mind altering substances?  Did anything else out of the ordinary or stressful happen?  Have you skipped or varied your dose?  

 

6 hours ago, Mattie said:

I will do what you suggested and make a daily symptom list and post it when I’m done

This sounds like a good plan.  Please post each day's journal in a separate post, and do it for 24 hours, so you and we can see your sleep patterns.  

 

I would also work on learning and applying some non drug coping techniques.  This will help a lot.  It won't take the symptoms away, but it will make them easier to live with.  This link will help you to decide which ones to learn, and what they are.  

 

Important topics about symptoms, including sleep problems

 

Edited February 15 by getofflex

[Mattie]

Thank you so much for your response. I feel a little hope now. I was thinking the worst kindling or my body rejecting the lexapro. Yes I’ve been feeling bad for years obviously I haven’t been stabilized since it all began in 2020. Also you asked me how I feel after taking meds. I take them at 8pm and usually get sleepy within 30 minutes but sometimes don’t get sleepy till 10. But the last few nights I’ve been falling asleep at 7pm . I think I’m in a wave of sorts. Other than that I don’t feel any adverse affects of the meds except get kinda drowsy and loopy . And about alcohol etc , I don’t drink or use recreational drugs etc. I do take vitamin d because I’m deficient and vit b12 and occasionally magnesium. And no I haven’t skipped any doses or had any out of the ordinary stresses. I will read all the info on non drug coping techniques. Thanks again 

[getofflex]

Just from what you say, it doesn't sounds like you are having an adverse reaction.  You don't have to keep the drug symptom journal, unless you want to.  As I said, I think you just need a very long time without any drug changes.  Each time we make a drug change, our nervous systems have to go through a cascade of complex adjustments to get used to the new drug regimen.  This takes a lot of time.  Be diligent about taking the same dose at the same time each day, not missing any doses.  I'll bet you will see gradual improvements, possibly with some windows and waves.  

[Mattie]

Thanks for your response. May I ask one more thing. The past 4 or 5 days have been extremely hard especially the depression. My adrenal surges had completely gone away but been back the last few days and last night I had them all night beginning about 11:45 and kept waking me up all night. Bad hurting in stomach and anxiety and depression. When I had them in the past, they wouldn’t start till around 4am. Is it normal for symptoms to return after subsiding? That was one symptom I was so glad to be rid of . Thanks 

[Mattie]

Also could you explain what an adverse reaction is ? Thanks 

[getofflex]

15 hours ago, Mattie said:

Is it normal for symptoms to return after subsiding?

Yes, this is called windows and waves, and it is totally normal for withdrawal.   Please read these next 2 links (first post of each) it's important to be educated about WD.  

 

Windows and Waves Pattern of Stabilization

 

Video on Recovery from Psych Drugs

 

12 hours ago, Mattie said:

Also could you explain what an adverse reaction is ?

An adverse reaction is the same as side effects.  It means that taking the drug itself causes symptoms.  We still do the 10% exponential taper unless the adverse reaction is severe, as in allergy or liver damage.  

 

Here is a link to a list of topics about adverse reaction. Please look over the first 3.  

 

https://www.survivingantidepressants.org/search/?&q=adverse&type=forums_topic&nodes=14,8&search_and_or=and&search_in=titles

[Mattie]

February 15 2024

1 am, 3:15am, 4:30 am, 6am woke up with adrenaline surges, exhaustion, deeply depressed , slight head pressure 

8:30 am breakfast low appetite 

9:45 crying spells, low mood, slight head pressure 

11:30 slight lift psychically, foggy headed,spacey, low mood 

1:00pm lunch, slightly better appetite 

2:30pm crying spell, hopelessness 

3:45pm mood slightly elevated 

6:00pm psychically more energy 

6:45 normal appetite 

8:00pm lexapro 5mg

8:30 slight head pressure, spacey, foggy 

10:00pm went to sleep 

12:15 am woke up, adrenaline rush, head pressure, hurting in stomach, depression 

1:00 am took magnesium 

1:30 fell asleep 

4:15 woke up to adrenaline rushes/ gut hurting/ despair 

 

 

 

I’ve decided if you don’t mind to submit a couple of days symptoms to the best of my ability, thanks 

[Mattie]

February 16 2024

6:00 am woke up anxiety/ gut hurting/ exhausted, depressed 

7:30 am breakfast low appetite 

8:45am crying spell, hopelessness, SI

want to sleep and never wake up but can’t sleep feeling 

12:45pm lunch low appetite 

2:00pm psychically a little more energy, low mood, slight head pressure 

5:45pm dinner low appetite 

7:00pm slight lift in mood and energy, not exhausted 

8:00pm 5mg lexapro 

8:45pm sleepy, slight head pressure, spacey 

9:30pm went to sleep 

1:15 am woke slight chest pain but quickly fell back asleep 

3:00am woke, slight gut hurting but quickly fell back asleep 

5:00am woke up, slight anxiety, depression bad, exhaustion, sleepy but can’t sleep feeling 

[getofflex]

Good job on the notes.  

[Mattie]

I’m reaching out again because the last few days I’m feeling worse. My symptoms are more intense like they were at the beginning of my updose. I’m basically couch bound and appetite declining with absolutely no motivation and blunted emotions which sends me into a panic. I haven’t gotten the slight relief from symptoms in the last couple of evenings also. Could this be adverse reaction happening now or just a terrible wave. I’ve read the info on adverse reactions and it’s a bit confusing because all the meds I’ve been on gave me horrible start up effects the same as withdrawals effects coming off or switching. Sorry for the rant just need reassurance to calm my nerves. Thank you so much for your time and patience.

[getofflex]

Here is how to know if you are having an adverse reaction - if you feel worse in the 4-5 hours after you take your drug.  Do you feel worse in the 4-5 hours after?  I suggest you keep doing your daily journal, as this will help you see symptom patterns. 

 

I suspect that this is a wave.   Do what you can to soothe and calm yourself.  What non drug coping skills are you using?  

[Mattie]

It’s hard to say if I feel worse in the first 4 to 5 hrs because after about an hour taking it I’m asleep for the next 4 hrs and probably my hardest sleep. It does make me sleepy, groggy, spacey and drugged and sometimes a gloomy feeling that’s why I take it at night. Is this adverse or normal. It’s just that before this wave I was starting to have a symptom pattern and was having better evenings and now I’m going down hill and feeling like back to first few weeks , it made me fear adverse reaction . So I guess what I’m asking is can the adverse reaction start at any point or would it have started before this wave since I was feeling a little better comparing to now. You mentioned continuing symptom journey. Do you want me to continue posting it or for my observation. Thank you so much for your time 

[getofflex]

On 2/20/2024 at 8:17 AM, Mattie said:

It’s hard to say if I feel worse in the first 4 to 5 hrs because after about an hour taking it I’m asleep for the next 4 hrs and probably my hardest sleep. It does make me sleepy, groggy, spacey and drugged and sometimes a gloomy feeling that’s why I take it at night. Is this adverse or normal.

It sounds like a slight adverse reaction to me.  However, this is unusual, because usually adverse reactions to Lexapro would be the opposite - anxiety, agitation, sleeplessness, ect.  However, it can affect different people in various ways.  It's lucky you are able to sleep it off.  

 

On 2/20/2024 at 8:17 AM, Mattie said:

. So I guess what I’m asking is can the adverse reaction start at any point or would it have started before this wave since I was feeling a little better comparing to now.

An adverse reaction can start at any time.  It sounds to me like you are currently in a wave as well, so you may be having both at this time.  However, I don't think your adverse reaction warrants you doing a fast taper.  

 

My suggestion to you would be to stick with your current dose of Lexapro, and ride out the wave using non drug coping skills.  

[Mattie]

Thanks for your response, another question please 

 If I’m having a slight adverse reaction 

 how does that affect my future taper.

 In other words how will I know that I 

 am stable enough to start a taper in a

 year or two if I’m still having 

 symptoms of a reaction especially if 

 the reaction feels like withdrawals  

 Thanks for your continuous support 

[getofflex]

11 hours ago, Mattie said:

If I’m having a slight adverse reaction 

 how does that affect my future taper.

With a slight adverse reaction, we still suggest you taper at 10% of your current dose, every 4-6 weeks.  A few people can go faster, but more often people need to go 4 weeks, and some have to go even slower.  

 

That being said, stability means that you are not having major ups and downs.  Have you read the link on stability?  That explains it well.  

 

Stability

 

It also helps to understand WD normal. 

 

WD Normal

 

The way to know an adverse reaction versus WD, is that the ADR (adverse reaction) occurs in the 4-5 hours after you take you drug, and the timing of the withdrawal symptoms are not related to when you take your drug.  So I would say that if you are having some symptoms after you take your drug, but otherwise are not having major symptoms, that would be stability for you.  

[Mattie]

Thank you very much for clarifying that. I can clearly see (now that you  gave me the understanding) that my withdrawals are effecting me significantly more than the adverse  reaction because all hell breaks loose starting around 4am. Im still waiting on the book you recommended to come in. I did have a slight window of relief and calmness around 7 pm and was enjoying the less intense symptoms  and clearer and calmer mindset until about 830 when my 8pm dose kicked in but the symptoms didn’t seem quite as intense last night and I was able to stay up till 10 instead of 830ish. Felt a little more in control of my body. Thanks again.

 

[getofflex]

1 hour ago, Mattie said:

all hell breaks loose starting around 4am

In all likelihood this is the early morning cortisol spike, which affects people in WD.  I'm very glad you had a window last night, and that the evening dose didn't affect you as much.  Here is info about the AM cortisol spike: 

 

Managing the AM Cortisol Spike

[Mattie]

Thanks, the cortisol spike makes sense. Also I forgot to take my vitamin d today and i noticed even though my symptoms were intense, they were noticeably a little less intense. Coincidence? I have to take it because I’m deficient. I also take b12 because I’m mostly vegan. Thanks 

[getofflex]

Vitamin D can be activating.  You might want to stop taking it, or reduce the dose, it's up to you.  Vitamin B 12 can also be activating, the same advice applies. 

Edited February 23 by getofflex

[Mattie]

Update: For the last 3 days I’ve been getting an earlier window starting around 5ish. Although it’s still not like before the drop/updose. I can actually feel the lift like a light switch, my depression goes away significantly and I physically feel so much better and functional more normal mindset. Is this a good sign? Any thoughts on how or why this happens? Unfortunately up until that point my symptoms are horrible as ever. Some days I can take comfort in knowing I’ll get an early window and some days especially when the depression is intense I can’t take comfort in anything. My book you recommended should be in any day now. Thanks for your continued support.

[Mattie]

I’m adding this question. If my anhedonia lifts a good bit at night, is that a sign that it’s withdrawal related and that eventually my mood can stabilize? Thanks 

[getofflex]

On 2/27/2024 at 7:53 AM, Mattie said:

Update: For the last 3 days I’ve been getting an earlier window starting around 5ish. Although it’s still not like before the drop/updose. I can actually feel the lift like a light switch, my depression goes away significantly and I physically feel so much better and functional more normal mindset. Is this a good sign? Any thoughts on how or why this happens?

Yes, this is an excellent sign.  It shows your brain is healing itself.  We don't know how this happens.  The brain is very complex.  

 

On 2/28/2024 at 8:33 AM, Mattie said:

If my anhedonia lifts a good bit at night, is that a sign that it’s withdrawal related and that eventually my mood can stabilize?

Yes, and yes. 

 

Here is a link that explains how to search our site.  You can search for "anhedonia", or anything else you are wondering about.  

 

How to Do a Site Search

 

Hang in there.  As you hold on your current dose for a long time, and take good care of yourself, and work on non drug techniques to manage your symptoms, you will gradually feel better. 

[Mattie]

4 months today since updose and im seemingly worse and my anxiety is more intense than usual tinnitus is also  worse. Depression is worse. Wave? Could the time change possibly have something to do with it? Being we sprang forward I’m now waking up at 5am which is 4am before the time change which means I’m not having any windows till 6 to 7pm when old time it was 5 to 6 . It’s just getting harder to have hope day in day out. If I could see tiny improvements I’d be more hopeful but it’s been extremely difficult this past 2 weeks. I did start reading the book you suggested but it takes time for me to process until my nightly window where I can read a page or two. I’m on page 37 I think. Thanks 

[getofflex]

It could be that you are in a wave at this time.  Yes, the time change could have something to do with it.  I will say that my withdrawal tends to get significantly worse with the seasonal change from winter to spring.  It could very well be this.  

 

Here are some things that can bring on waves: alcohol, COVID or other illness, taking antibiotics or other drugs/supplements, missing or varying doses, taking dose at various times of the day.  Has any of this happened?  

 

Waves can also be caused by stress, traveling and change in routine, too much physical activity, being outside in the heat, processed foods, excess salt, sugar, exposure to chemicals, mold, ect.  

 

Or, it could just be a wave that isn't caused by anything in particular.  Waves are a good time to sharpen those non drug coping skills.  

 

Important topics about symptoms, including sleep problems

Edited March 15 by getofflex