pushingthrough: Protracted Withdrawal/PWS from Fast Taper off 3yrs of 20mg Escitalopram (Lexapro/Cipralex)

[pushingthrough]

Hi everybody, posting this here in hopes of some help with taking next steps.
I was on 20mg/day escitalopram (aka lexapro/cipralex) for 3 years due to crippling anxiety that came out of nowhere (never had anxiety before), and despite taking good care of myself (sleep habits, nutritious diet, regular exercise, strong social relationships, etc), it persisted. So after 6 months, I decided to take the drug route. I didn’t notice any improvement with 10mg after a couple weeks so we upped it to 20mg (should’ve given 10mg more time).

 

My anxiety was brought under control without any serious side effects at first. After being on it for 1-2 years, I started to notice that I was always pretty tired and increasingly apathetic despite my good lifestyle practices and having always been an energetic and motivated person. By the end of the 3rd year, I was exhausted all the time with no motivation/enthusiasm, brain fog, and would literally need a nap 3 hours after waking up from 10hrs of sleep (caffeine/stimulants didn’t make a difference). A hard workout (I am a bodybuilder (no steroids tho)) would leave me crushed for several days, like a constant hangover. I was just chronically exhausted and lethargic and, possibly by extension of that or as a separate issue, depressed and unmotivated.

 

I did a 4-week taper from 20mg to 0mg without any issues at each reduction, spending several days at each dose to make sure I was stable before reducing again. I now know that was way too quick of a taper, but I didn’t have any adverse reactions to dose reductions, even after going down to 0mg, and my energy/mood seemed to improve at first. It has now been 7+ months since my last dose because I thought it was just a matter of time/toughing it out after you got all the way off. To make matters worse, my last doses were 10mg that I was alternating with 0mg, which I now know I shouldn’t have done. The only acute withdrawal symptom I had was some manageable vertigo, but the protracted withdrawal symptoms have been hell.

 

Despite great life circumstances and maintaining a good quality diet, sleep habits, and exercise routine, I am now almost always: exhausted, sad/depressed, lethargic, spacey, unenthusiastic, apathetic/anhedonic, irritable, moody, and sometimes anxious (though not nearly as bad as the original anxiety that I started taking the SSRI for). I don’t really enjoy doing much of anything any more and I feel like I could sleep forever. I’m lucky to work a job that is flexible, so I don’t need to set an alarm usually and typically get 9-10hrs of sleep. I still wake up tired every day and often need naps despite never being a nap person before. My sleep quality is good (no insomnia really)

 

My life is falling apart. I’m familiar with the waves and windows, and I’ve experienced one 2-week window, and the very rare goodish day here and there, during that 7-month period, but most days are crap . I have been tracking my mood/energy every day in a spreadsheet for last 3 months, and although I THINK I am doing a bit better now than I was during the first few months, it’s almost negligible, with awful days and chronic exhaustion still being the norm.

 

Given that I am 7+ months in, I don’t want to quit while being so “far along”, and I know that reinstatement is less likely to work now or may even have adverse effects (kindling), but I am starting to consider getting back on a very small dose (<1mg?) to get stable again before executing a proper taper in hopes of avoiding continued PWS. I’m 25 and I’ve basically lost the last 2 years of my life, which I know is nothing compared to some of the experiences on this site, but I’m hoping to get some guidance or input here since my doctor is pretty out of the loop on SSRI PWS (his suggestion was to start taking wellbutrin/buproprion, which I would rather not gamble with). It seems to me that I’m basically deciding between the risk of reinstatement resetting my withdrawal progress and not working/making things worse OR toughing it out for who knows how long, maybe forever, and possibly getting new, even worse, withdrawal symptoms as I know there is a possibility of experiencing new withdrawal symptoms many months down the road.

 

Some context notes: I am still able to consume most supplements (other than 5-HTP and melatonin) without any obvious adverse effects (for example, caffeine/pre-workout and nicotine gum/Zyn seem to be fine, although they aren’t as effective as they used to be) and I still lift weights very intensely since time away from training doesn't seem to help.Point being, I haven’t really been able to identify any trends as far as diet, supplementation, lifestyle habits, etc. causing waves, but perhaps it’s because I’ve been constant with everything. I also tried magic mushrooms (2g) and it had no effect acutely, although the following weeks were slightly better, that could’ve just been a natural “window”.

 

Any insight would be greatly appreciated as I am feeling hopeless.

 

[LotusRising]

Hi @pushingthrough

 

Welcome to SA,

 

We are a peer-run volunteer site dedicated to a harm reduction tapering approach in an effort to minimize withdrawal symptoms. As you have likely already seen, we suggest tapering by no more than 10% of your most recent dose each month.

 

Thank you for creating a signature. If you are taking any supplements currently, could you please add them.

 

It sounds like you've been doing all the right things with diet and lifestyle and I'm glad to hear you're also tracking symptoms, as this will be incredibly important if you decide to reinstate the medication.

 

I presume you have already read our topic on reinstatement, but if you haven't, please see it here Reinstating and Stabilizing. 

 

As you've mentioned, you can continue to wait it or out, or reinstate a very small dose. Unfortunately, if you go this route, no one can give you an exact timeline as to when (or if) you'll start feeling better, and while some will recover relatively easily, for others it can still take many months, or even longer. Reinstatement isn't a guarantee of diminished symptoms for everyone but it's certainly a reasonable tactic. Since you are outside of the 3 month timeframe where reinstatement predictably works, it may work and it may not. You may have already read on our site that these drugs are quite strong at lower doses, plus your system has become sensitized, so if you take too high of a dosage, it may be too much. 

 

In your case, you might try 0.5 - 1mg as a reinstatement dose. If it doesn't help or makes symptoms worse, I would stop. 

 

Please post any updates or questions related to your specific situation right here in your thread. It's helpful to keep everything related to your tapering journey in one spot and it helps to keep the site tidy. 

 

Reach out if you have any questions and again, welcome  

 

[pushingthrough]

@LotusRising thank you for the response.

Yes I have read the thread on reinstatement.

Am I correct in thinking that reinstatement at this late of a stage may come with the risk of "kindling" and bring me back to square one (rather than just temporary problems whilst taking it)? Even at as low of a dose as 0.5mg or less? I've seen a few others on this site say that has happened to them (with a low dose) and I don't think I can take that risk. Ideally, it would relieve the symptoms and I could just perform a proper taper from there. At almost 8 months off entirely though, I fear the risk of further destabilizing my nervous system is likely too high. And, being this far out, if it's a game of 1/100th of a mg, then I'm less likely to pick the right reinstatement dosage.

I've read a few posts saying good things about fish oil and magnesium. Do you have any insight/opinion there? I know everybody is different, but those seem to the most popular suggestions. I'm afraid to take anything that may facilitate serotonin production (mag) since melatonin and 5-HTP both caused an increase in depression symptoms the last time that I tried them; however, am I naïve to think that they may have a different effect now than they did before since some time has passed?

 

[LotusRising]

@pushingthrough

 

The reason we suggest such a small dose is to minimize the risk of a hypersensitivity/kindling reaction. In my experience, I knew within a couple doses that reinstatement wasn't working, and it did in fact set off a chain reaction of symptoms in my case. But as you know, we're all so different. 

 

14 minutes ago, pushingthrough said:

I've read a few posts saying good things about fish oil and magnesium.

 

Yes, we don't recommend a lot of supplements, but omega 3's and magnesium seem to help some. They are not a magic bullet, but omega 3's are certainly good for inflammation, which I presume these drugs contribute to in one way or another. I find magnesium helpful for general muscle relaxation and sleep, but it's very subtle. I take both and did try melatonin for a little bit at a very small dose. 

 

Omega 3

 

Magnesium

 

27 minutes ago, pushingthrough said:

however, am I naïve to think that they may have a different effect now than they did before since some time has passed?

 

I wish I could say definitively, but I just can't.

 

I tapered on to all my supplements by breaking open the capsules and this worked for me. 

 

 

 

[pushingthrough]

@LotusRising ok thank you for replying and for the insight. I appreciate your time.

To clarify, how far along were you when you tried reinstatement? And did it set you back in terms of rehabilitation progress, or more so just caused a temporary adverse reaction while you were taking it?

[LotusRising]

17 minutes ago, pushingthrough said:

o clarify, how far along were you when you tried reinstatement?

 

I was off buspar for 4 months when I tried reinstating. But I also tried a couple other AD's in between (for a week each) - this could have for sure contributed to my destabilization. 

 

18 minutes ago, pushingthrough said:

And did it set you back in terms of rehabilitation progress, or more so just caused a temporary adverse reaction while you were taking it?

 

I can't answer that, because I don't know for sure. I tried it for only 2 days and my symptoms escalated immediately, so I stopped the reinstatement, but unfortunately started using a benzo to counteract all the "sped up" symptoms I was experiencing, which I attributed to the buspar reinstatement. So, basically, it was complicated. I started tapering the benzo after only 3 weeks and had symptoms all the way down, but I can't say for sure if it was the reinstatement, or the benzo.

 

I tell you all of this because I think it's important to know that it doesn't work for everybody and there are a lot of contributing factors. 

 

I don't know that it would bring you back to square one, but I don't know for sure. As already mentioned, there is just simply no way to know for sure what will happen in your particular situation.

[pushingthrough]

@LotusRising ok thank you!

At this rate, I'm not even sure if I'm still experiencing withdrawal symptoms or just clinical depression, as one could've just blended/segued into the other. I've been tracking my symptoms/how I've been feeling for most of the last 8 months and there isn't really a definitive trend one way or the other, or even identifiable windows and waves. That is to say that I don't know if I can say I am generally feeling better now than I was in the first months after tapering off.

 

I know it's possible, but given that my drug history wasn't as "bad" as most others', it would seem less likely that I would experience very long protracted withdrawal (at the rate I'm recovering at, if at all, it will take years before I am normal again). And given that I'm on month 8 of feeling like this, I am starting to wonder if maybe I am just depressed.

I suppose that is the million dollar question many of us have.

[pushingthrough]

@Altostrata apologies for dragging you into this, but just curious if you have any insight on my situation. I'm sure you will agree with Lotus, as do I, but if you have anything to add based on your breadth of experience on this site it would be very much appreciated!

Thank you for your time

[Altostrata]

@LotusRising or another moderator will answer your questions.

[margaretLO]

On 1/9/2024 at 12:39 AM, pushingthrough said:

@LotusRising ok thank you!

At this rate, I'm not even sure if I'm still experiencing withdrawal symptoms or just clinical depression, as one could've just blended/segued into the other. I've been tracking my symptoms/how I've been feeling for most of the last 8 months and there isn't really a definitive trend one way or the other, or even identifiable windows and waves. That is to say that I don't know if I can say I am generally feeling better now than I was in the first months after tapering off.

 

I know it's possible, but given that my drug history wasn't as "bad" as most others', it would seem less likely that I would experience very long protracted withdrawal (at the rate I'm recovering at, if at all, it will take years before I am normal again). And given that I'm on month 8 of feeling like this, I am starting to wonder if maybe I am just depressed.

I suppose that is the million dollar question many of us have.

One girl had protracted withdraws for 3.5+ years because of 11 pills of escitalopram 

[Altostrata]

On 2/27/2024 at 6:37 AM, margaretLO said:

One girl had protracted withdraws for 3.5+ years because of 11 pills of escitalopram 

 

That would not be protracted withdrawal exactly, but this: Immediate adverse reactions to an antidepressant or within a few doses? How long for recovery?

[margaretLO]

40 minutes ago, Altostrata said:

 

That would not be protracted withdrawal exactly, but this: Immediate adverse reactions to an antidepressant or within a few doses? How long for recovery?

Υes i am sorry. 

I got confused because she developed more symptoms after she quit except the reaction.. 

 

For me that i got adverse reactions after long term use maybe is something similar but more delay? 

[Altostrata]

Please post questions about your own personal case in your Introductions topic, to keep this topic about pushingthrough.