Wortong: escitalopram fast taper - withdrawal

[Wortong]

Hello.

 

I am a 40 year old Male who has been suffering withdrawal from coming off 8 years of Escitalopram with what I have learned now was a too fast taper which was recommended by my GP

 

I have been through the wringer with a variety of distressing physical and psychological symptoms occurring in a windows and waves pattern for the past three and a half months and have since reinstated around 7-8 weeks ago as the withdrawal became too much to bear.

 

Although I felt the reinstatement was working at first I have recently ( over the last fortnight or so) had a disturbing intensification of withdrawal symptoms in which the waves are now dominating the windows and I feel I have gone backwards overall. I am too scared to taper off the 10mg as I feel that might make the withdrawal worse yet again and I am trying to stabilise.

[Wortong]

My symptoms started with dysphoria and an intense buzzing in the head and quickly progressed to tingling and burning in the head and sometimes body, a strange subjective numbness like feeling almost as if my brain is detached from the rest of my body, fatigue, flu like symptoms, head pressure and aches, panic attacks and terror thoughts and feelings, horrible enervated feeling throughout body at times. 
 

I was generally improving very slowly but reinstated because I got a wave got so bad I could hardly sleep for a week, woke up disoriented with sheer panic and literally thought I was dying.

 

After reinstatement of 5mg I had a strange and intense initial reaction of intense burning pain travelling rom my head to my gut and then bowel problems and diarrhoea for a few days, but then this cleared up. I thought I was improving with some reasonable days physically and mentally and derealisation and panic decreasing but a fortnight ago things have severely intensified with flu like symptoms, gut pain and burning headaches predominating. Waves have got longer And windows shorter. 
 

I’m scared to taper off the 10mg as I feel this might make withdrawal worse and I am still hopeful for stabilisation on the 10mg.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm sorry to hear of all the problems you are having with escitalopram.  It is a very strong drug (2x - 4x stronger than other SSRI drugs).  It sounds to me like you got withdrawal from tapering too fast.  You reinstated to 5 mg, then to 10 mg per the advice of your doctor.  You may have reinstated too high, or you could be in a wave.  Let me give you some basic information about these drugs, to help you understand why this is happening.  

 

Have you or are you taking any other drugs besides escitalopram?

 

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

 

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

Here is some information about reinstating, and about the risks associated with it.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

If you had come into this forum before reinstating, we would have advised you to reinstate at a very low dose to start, such as 0.5 mg of Lexapro.  This is because of the risk of kindling, described here:  

 

Hypersensitivity and Kindling

 

I suspect that you have either experienced kindling, or are in a wave.  I will confer with the other staff, and one of us will get back to you with suggestions on what to do.  In the meantime, hang in there, and I suggest you don't change or skip your dose while you are waiting.  

 

 

Edited November 2, 2022 by getofflex

[Wortong]

Thank you for your response @getofflex.

 

I have just come off quite a prolonged and severe wave which severely interrupted my sleep for a week. I was having quite bad flu like symptoms, moderate dizziness and imbalance feeling, burning head symptoms and horrible nervy feeling through most of the body with some nausea and stomach upset that for some reason was getting really bad after a period of sleep or even when I was trying to sleep. I would feel a little delirious and panicky when waking or trying to sleep.

 

I finally got some decent sleep the other night but still with the symptoms described above, but last night I slept a lot better with much less symptoms and no delirium or panic feelings, Since yesterday afternoon I have entered another window and probably feel better mentally than I have since withdrawal began. I still have dizziness and queasiness and some bowel discomfort issues but these have been slowly improving and the dizziness seems to improve as the day goes on. Unfortunately I am aware that as sure as night follows day there will be another wave coming at any time as is the pattern but I am encouraged that after I leave these waves I usually feel a bit better when I come out of them than the previous time.

 

I am religiously sticking to my 10mg dose at as close to 8:30am in the morning as I can, even to the second as I realise how important this is for the stability of my nervous system. I am wondering that if I have indeed kindled by going back on the higher dose of Escitalopram than recommended, If this will impede recovery staying on the 10mg or are the ever improving windows I am experiencing an encouraging sign even if I have come off a really bad and extended wave?

 

It really is quite shocking how trying to come off just one drug can cause such intense and frightening symptoms for so long and how so many people must be going through this given the ever increasing rates of long term antidepressant use worldwide.

 

 

[getofflex]

I'm very glad to hear that you are out of wave and having a nice pleasant window.  This is a very good sign.  

14 hours ago, Wortong said:

probably feel better mentally than I have since withdrawal began. I still have dizziness and queasiness and some bowel discomfort issues but these have been slowly improving and the dizziness seems to improve as the day goes on.

This is a great sign that your nervous system is stabilizing.  

 

14 hours ago, Wortong said:

Unfortunately I am aware that as sure as night follows day there will be another wave coming at any time as is the pattern but I am encouraged that after I leave these waves I usually feel a bit better when I come out of them than the previous time.

Again, this shows that your nervous system is stabilizing, which is what we want.   The windows and waves pattern of recovery is very typical, but it can be quite frustrating.  

 

14 hours ago, Wortong said:

I am wondering that if I have indeed kindled by going back on the higher dose of Escitalopram than recommended, If this will impede recovery staying on the 10mg or are the ever improving windows I am experiencing an encouraging sign even if I have come off a really bad and extended wave?

 

I would tend to go with the latter view.  I have brought up your case to the other staff, and we will see what they have to say. 

 

I sounds like you have a good attitude, and are doing well by maintaining your dose consistently.  Keep up the good work, it will really pay off in the end.  

[Lyudik]

Hi Wortong, 

I’m reaching out because I feel like we’re going through similar things at a similar time. Thanks for sharing your experience, it helps to feel that I’m not alone. Please update us on how things go! I’m wondering about going back up to 10 mg lexapro, but I’m afraid of kindling since 7 mg seemed to make things worse. I’m curious to know if you stabilize on the 10.

[Wortong]

Things are going relatively well at the moment. The past few days I have only had fairly mild symptoms and much more consistent with less fluctuations in symptoms over the course of the day. Sleep has been normal. I clearly feel like this period has been the best symptom wise since withdrawal began.

 

I still have mild gastrointestinal issues from time to time which seems to be gradually improving (was prone to this before I started drug, particularly stress induced IBS but withdrawal and reinstatement have probably triggered it), periods of weird subjective physical numbness, spaced out feeling a lot of the time and emotionally flat and uneasy, but these symptoms have decreased significantly. Brain burning, dizziness and tingling have also decreased quite a bit which is notable as these have been  probably the most consistent symptoms that I have felt from withdrawal.
 

I still don’t feel ‘normal’ like before the withdrawal started but the last few days have been easily tolerable with no panic symptoms and even starting to get some flashes of positive emotion back.

 

I am aware this is a window and more waves are likely to follow but I do feel like I am stabilising on the 10mg and recovering from any kindling I may have occurred as well (I am not having any notable reactions in the hours after taking my dose). Hopefully if stabilisation continues over the next weeks/months I will be in a position to consider tapering again, this time doing it the right way, slow and stable with the guidance of the experts on this forum rather than the clueless medical profession (I don’t blame GPs and mental health professionals per se as they have been hoodwinked just like we all have).

The psychological trauma of the whole experience will probably take longer to heal than the withdrawal so I am booked in see a clinical psychologist at the end of this month.

 

 

[Altostrata]

Hello, @Wortong

 

On 11/2/2022 at 3:24 PM, Wortong said:

I was having quite bad flu like symptoms, moderate dizziness and imbalance feeling, burning head symptoms and horrible nervy feeling through most of the body with some nausea and stomach upset that for some reason was getting really bad after a period of sleep or even when I was trying to sleep.

 

Is it possible that you had or have covid?

 

What are your most prominent current symptoms? Are your symptoms better or worse at any particular times of day?

 

Since September, did you ever miss or skip doses of escitalopram?

[Wortong]

Hello Altostrata.

 

I haven’t missed any doses since September.

 

I got Covid back in early May but I only had mild symptoms. I did get another illness probably only a few weeks before I stopped the drug completely that caused fever and fatigue for a day or so and mild respiratory symptoms but cleared up very quickly. I tested negative to Covid on that occasion (RAT test), although do have personal suspicions it might have been a a different omicron variant but have no evidence of this. I have had four doses of vaccine.

 

I suspect I do not have long covid as post exertional fatigue and general fatigue have never really been major symptoms and the psychological symptoms in my opinion have been too severe and weird along with the head symptoms and subjective numbness symptoms which are unlike anything I have felt before going off the drug.

 

My main symptoms at the moment are periods of mild queasiness and occasional IBS symptoms with occasional dizziness, subjective feelings of numbness through body that comes and goes (although there is no actual physical numbness anywhere), muscles feel tight at times and a bit shaky at times as well and a general sense of unease and mild brain fog that also comes and goes. I also find that when symptoms start flaring up my brain tingles and burns a bit and this eases back again when symptoms abate.  
 

Symptoms are very unpredictable and I can’t really pinpoint a particular time of day when they are worse or better. Maybe when I wake up in the morning they are a little bit more pronounced but I find getting up and active improves things. Sometimes the symptoms can come and go over the course of an hour but usually they cycle over a few hours or so. 
 

Overall symptoms are improving across the board. I find panic and anxiety symptoms as well as dissociative symptoms have improved the most but physical symptoms are much less severe compared to last week as well and easily the mildest they have been since withdrawal symptoms started in July.

 

 

 

 

 

[Altostrata]

12 minutes ago, Wortong said:

Overall symptoms are improving across the board. I find panic and anxiety symptoms as well as dissociative symptoms have improved the most but physical symptoms are much less severe compared to last week

 

This is the expected result of reinstatement after withdrawal symptoms. If I were you, I'd let my system continue to settle for some months before initiating another taper. FYI Tips for tapering off escitalopram (Lexapro)

 

Many people find fish oil and magnesium supplements helpful, see

 

https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

 

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

 

You might try a little bit of one at a time to see how it affects you. Please let us know how you’re doing.

 

Please let us know when you are ready to taper again.

[Wortong]

Thank you for the advice Altostrata.

 

That sounds like a good plan for now.

 

Still not feeling too bad today except for a bit of spaced out feeling, mild dizziness at times, a little uneasy, and stinging tingling brain feeling at times. Gastrointestinal symptoms and queasiness have been a lot less today.

 

 

[Wortong]

Improvement continuing at a slow but significant rate.

 

Most of my symptoms are now what I would call mild and no big waves, i.e. fairly stable from day to day. Still get occasional mild dizzy spells but they are only transient now. I am getting the odd headache and still some mild stinging feeling in head at times. I still feel very flat for at least part of the day and edginess and depressive states come and go and I also have transient periods of feeling very spaced out but this is improving slowly as well. Weird numb feelings are becoming less frequent and severe.

 

I feel like I will improve further over coming months if I hold for now. 

 

 

[Altostrata]

On 11/9/2022 at 9:50 PM, Wortong said:

I feel like I will improve further over coming months if I hold for now. 

 

 

Very likely. When the withdrawal symptoms have gone away, we can help you taper again.

[getofflex]

It sounds like overall, you are doing very well for someone in withdrawal (WD).  It if were me, I would hold on this dose of Lexapro for at least 6 or 9 months, to really give my nervous system a chance to settle, as Altostrata said, and get very stable.  I did a 9 month hold after I had done a couple of fast tapers and reinstatements, and it was quite beneficial.  Lexapro is extremely powerful, and the nervous system is incredibly complex, and takes quite a lot of time to sort itself all out.  

[Wortong]

Definitely agree with you there, getofflex.

 

Being hit with another wave at the moment. Bad flu like symptoms yesterday along with migraine like headache, dizziness on and off, mild nausea, mild stomach and bowel discomfort, fatigue, weakness and numbness, bad anxiety etc.

 

Today the flu like symptoms and headaches have eased off a fair bit but I still have anxiety, numbness like feelings and spells of dizziness. It had been about a week since the last wave. Previously to that I rarely had a window for more than a couple of days so I definitely feel like things have been improving in that regard. It will be interesting to see how  long this wave lasts and how I feel coming out of it as normally, the worse and longer the wave is the better I feel coming out of it, i.e. improvement on the last window.

 

This will definitely be a long process. 6 to 9 months probably sounds about right. I just hope that I continue to improve overall over this time and the windows start outlasting the waves.

[getofflex]

I'm sorry to hear you are in another wave, but glad that it's improved today from yesterday.  

 

1 hour ago, Wortong said:

normally, the worse and longer the wave is the better I feel coming out of it, i.e. improvement on the last window.

Yes, this is the typical pattern of recovery.  Your brain is stabilizing.  

 

1 hour ago, Wortong said:

I just hope that I continue to improve overall over this time and the windows start outlasting the waves.

You will, and they will, as long as you take good care of yourself, and practice natural self care.  Stay away from alcohol, caffeine, mind altering drugs, etc.  

[Wortong]

I’m still going through quite a bad wave at the moment, it has lasted about a week so far. 
 

I feel very anxious and a sort of traumatised feeling, I have been getting flu like symptoms, a lot of head pressure and tingling, sudden muscle tightness over my whole body and then numbness, also some nausea overnight and at other times. I also feel very spaced out like I’m floating through life and not really present.

 

I have had these symptoms before, basically throughout withdrawal but I guess the fact I was making good progress and now this latest wave has brought me right back down to earth it is probably hitting me particularly hard.

 

I have not changed my dosage or when I take the drug. Hopefully this is just a continuation of the general pattern and I get another window soon. 
 

I am wondering how long I should give this, if I don’t improve from here, before I can conclude that the reinstatement is not working, or can it take a long time, like the 6-9 months that I am recommended to hold for to stabilise fully?
 

[getofflex]

11 hours ago, Wortong said:

I am wondering how long I should give this, if I don’t improve from here, before I can conclude that the reinstatement is not working, or can it take a long time, like the 6-9 months that I am recommended to hold for to stabilise fully?

What I would do if I were you, is keep a daily journal.  Please see this link about how to do this.  What you want to do, is see how you feel before you take your daily dose, and how you feel in the few hours after you take it.  If you feel worse each time after you take your drug, that shows that you are having an adverse reaction.  We want to see what your symptom pattern is.  

 

Recording Drug Schedule and Symptoms to Track Patterns

 

Please post the results here. 

 

What you don't want to do, is react, and jump around on your dose of your drug because you are in a wave.  This puts you at risk of going from bad to worse.  Read this link: 

 

Considerations About Stability - Stop Jumping Around

[Altostrata]

You may have these spells for a while. They are normal for withdrawal syndrome. They should gradually fade over months. See The Windows and Waves Pattern of Stabilization

 

[Wortong]

Thanks @Altostrata

 

That’s good to know. 
 

I am willing to stick it out as long as it takes to stabilise.

 

I’m not quite as bad today. Feel somewhat better mentally, more with it than previous days. Physically I am very keyed up and have had periods of intense muscle tightness all over the last couple of days and a bit shaky with relatively short periods of fast heart rate. When the tightness resolves I often get achy for a while and then that resolves eventually.
 

I had quite good sleep last night, no nausea waking me up or any major symptoms.

 

I think I notice the dizziness has slowly decreased over the past few days and that has been the most persistent symptom since day one, (it was the first physical symptom I noticed).