ezzytalloprawn

[ezzytalloprawn]

Hi all,

I have a 16 year history on SSRI/SNRI (see signature) as well as a few years on Mirtazapine and one year on Bupropion. The two latter I quit fairly easy without any tapering worth mentioning. I'm also a medical doctor.

 

I've read this forum now and it's been very helpful. The main reason I'm now registering is I'd like to contribute to the Escitalopram tapering thread, where there seems to be a quite well established misconception about the water solubility of the drug (I don't seem to be able to repy there yet though). 

 

Escitalopram is, as the post states, "sparingly soluble" in water (and "soluble" in saline water). Sparingly soluble by definition means that it takes 30-100 ml of water to fully dissolve 1 g of a chemical (such as a drug). (I'll still to 100 ml instead of 30 - 100 ml for simplicity, and 100 ml is at the less solvable end of the spectrum)

 

1 g is 1000 mg. So, with 100 ml of water you can dissolve ONE HUNDRED 10 mg pills of Escitalopram (as the salt Escitalopram oxalate). To dissolve one 10 mg pill, you need only 1 ml of water.

 

I suspect most people will use much more water than this, as 1. there is no reason to work with such a small amount of water and 2. people seem to think you need lots of water. So, let's say that you use 10 ml or more instead of the necessary 1 ml. Now, there is NO reason whatsoever to increase solubility by adding sodium chloride (i e, making a saline solution), worrying about decreased solubility in refrigerator temperatures, etc.

 

Note, there is stuff in the pills that does not dissolve, but the active drug does, easily.

 

On the term "sparingly soluble": from a required 30-100 ml of water to dissolve 1 g of Escitalopram follows that in 100 ml water the amount of solvable Escitalopram is 1 - 3.3333333... g. Compare this to table salt (sodium chloride) which I believe you can dissolve 36 g of in 100 ml of water. Hence, it is easy to understand why "sparingly" is appropriate.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Thank you for the information on solubility of escitalopram.  I've reported this to our staff, and we will get back to you on that.  In the meantime, I'd like to discuss your current escitalopram tapering.  Have you been having any symptoms since you reduced to 7.5, and then to 5.0 in November?  If so, what are they?

 

Did you have symptoms went you made the past switches to fluoxetine and then to escitalopram?  What were they? 

 

 

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

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Escitalopram

 

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

 

 

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

 

If it were me, I would hold for a while on your current dose of 5 mg escitalopram, which is a very powerful drug, and much stronger than other SSRI drugs milligram per milligram.  I would suggest holding for at least 6 months, maybe even 9 or 12 months.  We on this site practice a harm reduction approach, and once the nervous system is destabilized, it can take a long time to stabilize.  Please let us know how you are doing.  

[getofflex]

On 11/23/2022 at 2:40 AM, ezzytalloprawn said:

a few years on Mirtazapine and one year on Bupropion. The two latter I quit fairly easy without any tapering worth mentioning.

How recent was this?  What year(s)? 

[Trakker]

On 11/23/2022 at 1:40 PM, ezzytalloprawn said:

I suspect most people will use much more water than this, as 1. there is no reason to work with such a small amount of water and 2. people seem to think you need lots of water. So, let's say that you use 10 ml or more instead of the necessary 1 ml. Now, there is NO reason whatsoever to increase solubility by adding sodium chloride (i e, making a saline solution), worrying about decreased solubility in refrigerator temperatures, etc.

I am dissolving 5 mg Lexapro into 50 ml of water without any salt and storing it in the refrigerator for about a week.  The tablet weight is 135 mg.  It seems to evenly dissolve in water with no visible insoluble parts.  I shake the solution well before taking liquid out with a syringe.  Is this OK?  Does the effectiveness of Lexapro change when dissolved in water? 

[Altostrata]

Thanks for the information, @ezzytalloprawn

 

Please do add your clarifying comments to Tips for tapering off escitalopram (Lexapro)

[ezzytalloprawn]

On 12/5/2022 at 6:27 PM, Altostrata said:

Thanks for the information, @ezzytalloprawn

 

Please do add your clarifying comments to Tips for tapering off escitalopram (Lexapro)

My pleasure!

 

However, I don't seem to be entrusted to post there. Feel free to add it, modify the wording, etc, if you want to!

 

Edit: I can see this post (not approved yet) but I can't at all see my very long reply to the previous questions, which took an hour to write. Did this reply erase the my other reply or is it just not visible to me until approved?

[manymoretodays]

Hi ezzytalloprawn, @ezzytalloprawn

Check up above.  Your post of November 23rd is up there.

Are there any others still missing?  I can go find them, if so.  Possibly not immediately but as soon as possible.

 

And okay, you should be able to post in the escitalopram topic now too, in a reply.  You might not immediately see it, but if you'd like to copy and then paste part of your November 23rd post in a reply there, that would be good.  It would certainly save us, staff time.

 

Thanks, welcome aboard.  Looks like you've got some distance still to go with your escitalopram taper.

I hope you will go with a harm reduction taper from here on out. 10% or less of each previous dose.  I do see the topics have that have been given above, and so, I won't repeat. 

I will only encourage you to slow down your taper now.  Especially at the lower doses, we often see the plasma binding has more drastic changes dose to dose.

Why taper? SERT transporter studies show importance of gradual change in plasma concentration

 

and this one includes escitalopram:

Regional differences in SERT occupancy after acute and prolonged SSRI intake investigated by brain PET

 

Okay, and welcome aboard,

Best, Love, peace, healing, and growth,

moderator manymoretodays(mmt)

Edited December 6, 2022 by manymoretodays
added notification, spelling too-grammar

[ezzytalloprawn]

On 12/6/2022 at 9:08 PM, manymoretodays said:

Hi ezzytalloprawn, @ezzytalloprawn

Check up above.  Your post of November 23rd is up there.

Are there any others still missing?  I can go find them, if so.  Possibly not immediately but as soon as possible.

 

And okay, you should be able to post in the escitalopram topic now too, in a reply.  You might not immediately see it, but if you'd like to copy and then paste part of your November 23rd post in a reply there, that would be good.  It would certainly save us, staff time.

 

Thanks, welcome aboard.  Looks like you've got some distance still to go with your escitalopram taper.

I hope you will go with a harm reduction taper from here on out. 10% or less of each previous dose.  I do see the topics have that have been given above, and so, I won't repeat. 

I will only encourage you to slow down your taper now.  Especially at the lower doses, we often see the plasma binding has more drastic changes dose to dose.

Why taper? SERT transporter studies show importance of gradual change in plasma concentration

 

and this one includes escitalopram:

Regional differences in SERT occupancy after acute and prolonged SSRI intake investigated by brain PET

 

Okay, and welcome aboard,

Best, Love, peace, healing, and growth,

moderator manymoretodays(mmt)

Thank you! 

Yes, there's one missing. I'm referring to a long reply I wrote yesterday, where I wrote an essay more or less, answering getofflex questions on withdrawal so far, my switches between venlafaxine, fluoxetine and escitalopram, my tapering from bupropion and mirtazapin, as well as a few other things lol. Hopefully there's something you can find, if not I'll try to find time to write it again. It was probably too long anyway. 

 

Yes, indeed I have some way to go. Thank you all for your recommendations, links, support.