Ladyhawke - Guidance for possible ineffective reinstatement Escitalopram

[Ladyhawke]

Thank you for your guidance and support to so many people.  I truly appreciate any help you can provide me. 

 

Like so many before me, I foolishly quick tapered off Escitalopram last March-April 2022 over a 4-6 week period.  I was fine for awhile but got hit hard with withdrawal symptoms approximately 3 months out.  I did visit my GP in Sept 2022 with my symptoms and asked if it could be related to taking myself off the drug.  He didn't seem overly concerned and nonchalantly stated; "You can take it and see if it helps".  Foolishly, I dismissed this because he was more concerned that I get tested for sleep apnea due to my husbands concern with my breathing while I slept. I spent 4 months struggling with an ineffective CPAP treatment only to find out that I didn't have sleep apnea and thought this was the reason for my symptoms.  I spent the 7 months visiting various doctors, under going numerous medical tests & went to the ER two times in my quest to find out what was wrong with me.  The good news is that all medical tests came back negative. After waiting 4 months for a neurologist appt, I was diagnosed with depression on April 7, 2023.  At that time, I told them I took myself off lexapro the year prior and they stated my body was not producing the serotonin it needed and I should go back on the medication. They said you are at the end of your road, go back on the drug and you will feel much better.  The 2nd big mistake that I made was going back on the drug instead of riding it out. 

 

On April 8, 2023 I started escitalopram at too high of a dose and I have bounced around during the last 68 days with the majority of time in the lower dosage of 2.5/2.6 mgs.  My GP does not have a clue about this medicine and I can't rely on him at all to give my the proper guidance.  He knows that I have been having a very tough time and knows that I felt the medicine is too strong.  He is supportive with whatever I want to do like prescribing the liquid form of the medicine but I have not made good choices and I feel I'm in limbo with what to do next.  I should have done all of the research on your site long before I tapered the drug in the first place but now I'm grateful I found you.

 

I have had withdrawal symptoms since last summer & I still have them while I'm on the drug:

-Insomnia - I fall asleep but only to wake up a few hours later. Sometimes I can fall back asleep but other times I am up for hours.  This is an ongoing issue. 

-Brain Fog - my brain is definitely not functioning at the same level. I can't remember things and I feel blocked.

-Dizziness/Wooziness - off balance.

-Vision - my sight has definitely been impacted. 

-Little appetite - I don't find pleasure in food anymore. Lost over 20 lbs.  I'm grateful that my husband has been cooking and food shopping.

-Excessive dry mouth

-Lack of emotion

-Very sensitive to stress 

- I have an internal shakiness that I didn't have prior to the reinstatement and it's worse leading up to taking the medicine in the morning at 8:30AM.  

 

I don't feel the reinstatement has helped me and my 3rd mistake was not stopping it prior to the month end. I am still suffering the same withdrawal symptoms that I had prior to the reinstatement.  I'm on the medication for 68 days now and I realize I am dependent on it but if I'm not feeling any better.  I have been at 2.5/2.6 mgs for approximately 5 weeks.  

Is it realistic to believe that I should be feeling better at this point?  

Do I continue to stay at this dose even though I am still suffering the same symptoms?

 

Thank you in advance for your time & guidance. 

 

 

 

 

 

 

[Altostrata]

Welcome, @Ladyhawke

 

Are you taking 2.6mg escitalopram now? What time o'clock do you take it? Any other drugs?

 

How has your symptom pattern changed in the last week? What is your sleep pattern?

 

[Ladyhawke]

Hi Altostrata, Thank you so much for your reply.  You are truly inspirational and your support to this community is admirable. 

 

Yes, I have been taking 2.6mgs of liquid escitalopram @ 8:30 AM for 17 days.  

 

I don't take any other drugs.  I was given a prescription for Ativan & Lorazepam from my GP to help with insomnia but I don't want to take any other drugs especially since reading the info on this site.  My GP knows I want to get off of the meds & he is in agreement that I should get off especially since I have been having such a difficult time.

 

My sleep pattern is awful. The last couple of nights I haven't been able to fall asleep easily or stay asleep. 

 

The insomnia is the most upsetting symptom for me and I have had it for many months. I tried .5 mg of Melatonin & chamomile tea but I still wake up in the middle of the night.  I tried epsom baths too but I can't say that I have done any of these things for a long length of time. I can't seem to settle down & I can't nap.

 

I bought the Pure Encapsulation magnesium glycinate 120 mgs & I was thinking of trying it to see how it affects me.  It's a capsule & I was going try half rather than the full capsule in water or tea tonight.  My husband wants me to try to take Benadryl or Advil PM so that I can sleep a couple of nights. I know if I could sleep better I would get healthier quicker.  

 

Thank you again for your time. 

 

 

 

[Altostrata]

What effect does 2.6mg escitalopram have on you?

 

Do you take any other drugs, with their dosages? Are your symptoms better or worse at any times of day?

[Ladyhawke]

Hi,

 

I am not taking any other drugs.  

 

I take 2.6mgs of liquid escitalopram at 8:30AM.

Lately, I have been feeling tired/sleepy/low energy in the morning hours.

I tend to feel my best in the afternoon hours thru dinner time.

Most nights I can fall asleep around 10/10:30PM but I wake up multiple times in the evening.

I feel most activated during those wake ups.  Nausea builds thru the night & I get jittery/internal shaking.  

 

I tried taking Omega 3 Omega Via EPA 780mg/DHA 260mg/DPA 10mg/Other Omega 3's 55mg - 3 days ago and it affected my sleep that evening.  I have not taken any more and may try to find a lower dose alternative.

I have been taking 165 mg of Calm Magnesium carbonate in a tall glass of water during the day. Sipping on it. 

My GP wants me to continue to take Vit D.  I take 2000 IU of Vit D-3 but not everyday. 

I have a cup of chamomile tea before going to sleep.

I have tried Melatonin on various nights.  .5mg.  I still wake up in the middle of the night.

 

Symptoms:

-Insomnia - I fall asleep but only to wake up a few hours later. Sometimes I can fall back asleep but other times I am up for hours.  This is an ongoing issue. 

-Brain Fog - my brain is definitely not functioning at the same level.  My memory is affected and I feel blocked.  

-Dizziness/Wooziness - off balance.  Worse on the days with limited sleep.

-Vision - my sight has definitely been impacted. Dry eyes. My eyes look dead - no life to them.  This has been ongoing during withdrawal & now.

-Little appetite - I don't find pleasure in food anymore. Lost over 20 lbs. 

-Excessive dry mouth. - ongoing during withdrawal & on med

-Bruxism - during withdrawal & On med. 

 

-Lack of emotion - I feel very flat/depressed state. Unmotivated.  Blunted.  (This has gotten worse since reinstatement)

-Very sensitive to stress 

- I have an internal shakiness that I didn't have prior to the reinstatement and it's worse leading up to taking the medicine in the morning at 8:30AM.  

 

I am in limbo on my next steps. Like so many people ask on this forum, its hard to know whether to updose, taper, etc.   I have had all of my symptoms during withdrawal and I still have them. 

 

It's been a year since withdrawal symptoms started from a too quick taper and this reinstatement has set me back.  If it significantly helped me it would have been worth it but it hasn't. 

 

My doctor & I discussed tapering several weeks ago because I didn't feel the med was helping me. I have been sticking to the same dosage until I hear your thoughts. 

 

Thank you for your help & guidance. 

 

 

[Altostrata]

27 minutes ago, Ladyhawke said:

I take 2.6mgs of liquid escitalopram at 8:30AM.

Lately, I have been feeling tired/sleepy/low energy in the morning hours.

I tend to feel my best in the afternoon hours thru dinner time.

 

Did you always take escitalopram in the morning? Did it always make you feel sleepy? 

[Ladyhawke]

Yes, I always took escitalopram in the morning and it never affected me like it does now.  Also, I didn't have insomnia either. 

 

Edited June 20, 2023 by Ladyhawke

[Altostrata]

Is the dose you're taking in the morning making you sleepy?

[Ladyhawke]

Hi Altostrata,

 

I'm exhausted from the lack of quality sleep & I feel tired before I take the pill.  I don't feel that the pill is making me sleepy.  

[Altostrata]

How has your symptom pattern changed since May 19?

[Ladyhawke]

Altostrata, Thank you for your continued support.

 

I have had windows where I felt good for a day and slept better than normal but the majority of time I have had insomnia along with the other symptoms I noted. I think they are less pronounced.   I do have some days that I feel terrible but overall I am functioning but not at an optimal level or anywhere near at the level I was before I stopped the drug. 

 

 Prior to reinstating, I had windows where I started to sleep too and some of the withdrawal symptoms started to improve.  It was almost a year between going off the drug and going back on the drug. 

 

Many of my symptoms have persisted both during withdrawal & reinstatement which leads me to question the reinstatement effectiveness & why do I have the same symptoms?  Am I still withdrawing? Is the drug working or not working? Do I need to give it more time (I'm on the drug 77 days)? is it the right dosage? 

 

At this point, I am now dependent on it and I will need to slowly taper when the time is right.  Like everyone else on this site I just want to get better so that I can start living fully again sooner rather than later.  

 

 

[Altostrata]

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. We need to know how you feel before and after each dose. Please include your sleep pattern.

[Ladyhawke]

Typical pattern:

 

10:30-10:45 PM Fall asleep

1-2AM Wake-up (sometimes feel activated) sometimes take 1/2 Benadryl pill (12.5 mgs) to fall back asleep

(brain tingling)

3AM- Back to sleep (brain tingling)

6:30AM Awake - rest in bed (brain tingling)

7AM Get up (usually feed tired & drained in the morning)

8AM Eat Breakfast, 1/2 cup coffee

8:30AM Escitalopram (currently at 3.4 mgs liquid)

10-10:30AM Take Vit D (2000 IU) & Omega 3 (1300 mg)

10:30-11:30 AM start to feel more energized & begin feeling better

1PM - Lunch

2PM -5PM Sometimes I feel my best during this time but today I have brain tingling, internal trembling/shakiness

*Everyday I feel woozy (dizzy), vision issues - has been ongoing for almost a year.

 

Symptoms during protracted withdrawal & remain while I am on the drug:

Insomnia

Brain fog

Dizzy/wooziness

Blurry vision 

Feeling numb

Dry mouth

Depressed

Lack of sex drive

Lack of interest in food

 

I updosed last week because I felt very depressed. The doctor wanted me to go up to 5mgs but I was afraid to increase that much. As expected, my GP blames the low dosage for me not feeling better. The endocrinologist agrees that the dosage is too low to be effective.  I tried to explain to both of them that I felt very activated when I was on the higher doses early on and it made me feel scattered & crazy.  I told the GP that I want to come off the drug and he agrees because he doesn't feel it's effective at this dosage. He continues to give me aggressive tapering advice such as drop to 1.5 mgs for a week then 1 mgs next week and then stop.  The endocrinologist said that 90% of people can come off the antidepressants with little difficulty and I must be in the 10%.  

 

A psychiatric provider (PA) thinks Escitalopram is no longer effective and that I suffered for too long.  Her tapering advice is to drop to 2.5 mgs for a week & then 2.5 mg every other day for a week & stop.  She advises taking it in the evening rather than the morning.  She wants to switch me to mirtazapine at 7.5 mgs when I stop the Escitalopram.  She feels that my dizziness is due to inconsistent dosing of escitalopram & not sleeping well.  She does not think the liquid dosing is reliable and she prefers pill form. 

 

I told her that I would taper slowly over a longer period of time and after what I have been through I no longer will go on a drug without research. I told her I am very apprehensive about going on any other psychotropic medicine because of how sick I am as a result of coming off of them.  I asked her why would she put me on an atypical antidepressant rather than another SSRI like Celexa?   She said because I did not respond well to the majority increased serotonin she would be hesitant to try another serotonin focused medication next.  She said Celexa is still a good option and it's less stimulating than escitalopram & she said it's a relatively easy to get off of in comparison to other SSRI's!!  

 

If I had not known about this site and the correct way to taper this would have been the advice I would have followed.  

 

I am hoping you can provide advice on what I should do next.  I am confused due to the brain tingling that has been ongoing for weeks.  Am I experiencing interdose withdrawal? Should I try updosing or taking 2 doses a day? Should I updose to get more stable before tapering?

 

Thank you for your invaluable guidance. 

 

 

 

 

 

 

[Altostrata]

Hello, I need your actual notes day by day. Thanks.