skyline069: Escitalopram/Lexapro - Could this still be prolonged withdrawal

[skyline069]

Dear Survivingantidepressants-community,

 

during my recent problems with psychiatric drug withdrawal I have become an attentive reader of your forum - always regretting that I didn't come across it - or the philosophy behind it - before my whole story with withdrawal started. Please don't disregard my question on the basis that I'm not yet in a position to taper since I have been polydruged in hospital during an acute crisis. The crisis is now under control so I'm now able to evaluate my situation with a clear mind.

 

To put it in very short terms: I have been on and of Escitalopram 5 mg for the entirety of my 20s and early 30s. It was prescribed for the usual mixture of panic/anxiety and depression. I never had a hard time with the drug and it always did what it was supposed to do so I remained in a state of total naiveté regarding the effects of abrupt discontinuation and reinstatement during the four or five times I tried to get rid of the drug. 

My luck turned in late 2023 when I went without the drug for 6 months (cold turkey) only to realize that I have developed a mild form of PSSD in the process of discontinuation. I tried reinstating the drug almost immediately at 2,5 mg (stupid, I know) which gave me serotonin syndrome, agitation and got me hospitalized.

In hospital they put me on Lorazepam 4x a day 0.5 mg. First I refused to take any further antidepressants, but my depressive symptoms got out of hand quickly and I developed an episode of depressive psychosis which resulted in a drug cocktail including Risperidon, Quetiapine and Wellburtin.

 

Leaving the basic facts behind I now want to describe the situation that puzzles me so much at the moment: My depressive symptoms are unlike any depression I have experienced so far. Wellburtin and Lorazepam have mellowed it but I still feel it underlying my current state. Far more than a reactive depression it feels like a neuro-depression, meaning that it is oddly detached from reality and seems to be a painful buzzing in my brain and chest. Now being polydruged I still feel the underlying agitation, non stop raised heart rate and pounding and I'm mostly only able to fall asleep with the help of said drugs. My question is the following one: Do you think that SSRI-Prolonged withdrawal syndrome could still play a role here? During the 6 months I went without the drug I didn't notice severe symptoms apart from the subtle ones of PSSD which took me months to even notice. Otherwise I'm at loss at explaining the weirdness and severity of my symptoms which persist even though I'm treated with anti-psychotics and benzos.

 

Any help or suggestion is gratefully welcomed.

 

[Onmyway]

Hi @skyline069

welcome to SA. Thank you for completing your signature. Sorry you have had such a difficult time that required hospitalization. I can't imagine how scary it must be to have psychotic depression. 

 

Do these symptoms seem to you as side effects more than withdrawal? Side effects would ramp up after you take up your medicines - within a couple of hours.  I am assuming that wellbutrin would cause some agitation while the lorazepam and quetiapine may tone things down. How do you react to wellbutrine and risperidone within a few hours? When do you take your medicines? Is there a pattern to your symptoms during the day? 

 

I will be back when you answer these questions. 
OMW

 

[skyline069]

Hi Onmyway,

 

thank you for your quick and kind answer. I take Wellburtin in the morning, Risperidone at noon and Quetiapine in the evening. Since I took one pill of 5 mg Escitalopram four weeks ago I feel as if the underlying agitation hasn't gone away and is just masked by the other Meds. Wellburtin has taken away the edge of acute depression and Quentiapine allows me to sleep, Lorazepam probably keeps things at bay as well, but there is this ongoing agitation in the background that swells up and down mostly without a clear pattern but peaks in the morning. I suspect that maybe my brain is still adapting to the lack of Escitalopram (I also have symptoms of PSSD which seems to be in favour of this theory). If this would be the case and I'm still in some kind of withdrawal situation I could at least be hopeful that I come out of this state sooner or later.

[skyline069]

I realized that I didn't clearly answer the question: No I don't think these are side effects since I don't experience peaks after taking them. The meds rather hold at bay a state that started with my adverse reaction to 5 mg escitalopram four weeks ago. The doctors want me to taper Lorazepam soon which makes me afraid that the underlying agitation will become hard to manage again. If I knew that this was some kind of withdrawal symptom I could at least see the light at the end of the tunnel.

 

 

 

 

[Onmyway]

Hi @skyline069

it sounds to me like an unsettling of the nervous system (which is what withdrawal is ultimately) which does go away slowly with stability. Once you are in withdrawal, introduction of a new or sometimes the same old medicine can cause an adverse reaction (in your case escitalopram). It doesn't seem that you have an adverse reaction to your current medicines.

 

Doctors are worried about addiction from benzos (lorazepam) and may force you to come off of it soon. That may destabilize things further. If you can ask them to follow the SA protocol for coming off of lorazepam rather than a faster one, it may not destabilize things too much. We usually recommend cutting no more than 10% of previous dose every 4 weeks. If you are not forced to taper off now, we'd recommend not changing anything for a few months. 

 

Have a look at the Symptoms and Self Care forum to see if others have your symptoms and what may have worked for them. 

Hope things get better soon. 

OMW

Edited January 4 by Onmyway

[skyline069]

How can I stabilize myself further in this situation? Right now the electric buzz of withdrawal seems unbearable. I think Wellburtin lost its efficacy. Should I go up in dosage or increace the Lorazepam dose for now? Or just try to wait it out? 

[Ck1111]

.

[skyline069]

Hi SA-Community,

 

I have an update to make and hope that someone can help me identify my symptoms. 

I recently missed two doses of risperidone and the weirdest Things started happening. Over the course of the following days my head felt like it was about to explode, I head a weird tingling sensation in head and neck and bouts of worsening anxiety DP/DR feeling as if my body was weightless and so on. All of this culminated in a series of seizures that lasted for hours at a time and left me thinking I was about to die. After each seizure I had the impression that I have been more removed from life and my surroundings and more anhedonic. Now my whole body aches 24/7 like the capacity to feel comfort and pleasure through my body has been removed my body and mind is a continuum of nerve pain, depression and anxiety as if my dopaminergic system throughout my body just died. Can anyone help me to find out what could have happened. 

[skyline069]

A small update from me for documentation's sake. Mainly to draw attention to the dangers of kindling and a textbook example of how not to proceed when encountering withdrawal problems. Maybe someone can avoid the mistakes I've made. 

 

I think I might be in posession of the most kidled brain in the history of medication withdrawal. Okay that might be an overstatement and I'm aware of other severe cases but hear me out.  My ordeal started exactly one year ago when I tried to reinstate Lexapro 5 mg after being off for 6 months and about 10 years of use. At this point I had already developed mild symptoms of PSSD and the adverse reaction was horrendous and landed me in hospital. There the doctors persuaded me to take seroquel to calm me down, 25 mg of it almost got me killed and wrecked my nervous system in unimaginable ways besides actually inducing psychosis. All of this triggered a horrible vicious circle because now they forced further drugs on me - severely harmed and kindled already I ended up on no less than 4 drugs. Risperidone, Seroquel, Wellbutrin and Mitrazipine. After missing a dose of Risperidone in early march my brain and nervous system seriously started to completely self destruct. The damage now was not only in my brain but extended to my whole body as I suffered through unimaginably painful seizures. Different to other sufferers' reports of seizures that have transient effects, in my case they've have done lasting damage and left my body in a weirdly numb, tense and aching state from which there's no respite. I'm severly anhedonic, maybe 5% of hedonic tone left, can't focus, have lost all emotions and interests I once held am bedbound most of the time and just barely able to look after myself.

 

Now I have seen what unimaginably severe damage the skipping of a single dose of 0,5 mg risperidone has done to my already burning system and I face the fact that I'm still on 3 extremely powerful meds at high doses. I'm so hypersensitive that a cigarette or caffeine can trigger severe reactions. I basically feel the toxic and detrimental effect of every neuroactive substance I happen to consum in whatever small amounts. I try to microtaper Mirtazipine right now and am down to from 45 to 40 mg in about three months but I keep declining and I'm not sure if it's even worth the gamble to taper under these circumstances and if ot wouldn't be better to just keep taking the drugs til the end. 

 

All of this doesn't even touch on my worst symptom which is unrelenting, non stop extreme tardive dysphoria/depression that just keeps deepening and deepening as whatever destruction is happening in my brain directly affects on my "mood" which even seems to be a wrong expression for the acidic, all consuming feeling of despair I'm engulfed in. The only respite I get from this is an occasional klonopin that lifts the dysphoria to some 50% and allows my body to relax a tiny bit. But we all know what path this could lead me down if I happened to abuse this only aid I have left as I'm completely 100% resistant to the beneficial effects of any other drugs or supplements and risk ever worsening crashes if I'd happen to try something.

 

So yeah guys. Kindling is a horrible thing. All it took to start this spiral were 3 or 4 CTs of Lexapro over the course of 10 years and a couple of stupid decisions and now I have to live with the consequences of the most torturous neurodegeneration. 

 

What do you all think. Is tapering worth the trouble under such hopelessly adverse circumstances?

[FireflyFyte]

19 hours ago, skyline069 said:

What do you all think. Is tapering worth the trouble under such hopelessly adverse circumstances?

 

There is hope but would recommend considering a hold to see if you stabilize, or even improve slightly, before beginning a taper.

 

Can you detail at what times you take your current medication and at what dosage?

Edited Friday at 07:13 PM by FireflyFyte

[skyline069]

1 hour ago, FireflyFyte said:

 

There is hope but would recommend considering a hold to see if you stabilize, or even improve slightly, before beginning a taper.

 

Can you detail at what times you take your current medication and at what dosage?

Thanks for the reply. I take 450 mg Wellbutrin XR around 12 am. 100 mg Seroquel XR and 40 mg Mirtazipine at around 10 pm. 

 

The problem with holding as I see it is this: I'm well past "regular" withdrawal symptoms. There is clearly ongoing damage happening and since March I haven't reached any kind of baseline but rather steadily declined. So in my book I face two options: 

1. Staying on the current doses and keep declining while my brain keeps building up ever increasing dependece and possibly facing tolerance issues in the foreseeable future. Also risking to get completely destroyed by supply shortages etc. which was already on the horizon with seeoquel. 

2. Tapering reasonably fast (which still will be slow), declining, but at least approaching a situation where I would be drug free in about 2 years and could hope for some kind of baseline to manifest. 

 

Both ways seem to imply extreme suffering but I think it would make me.mad to just passively swallow the pills in the hope of some stabilization that I hardly see coming at all. 

[FireflyFyte]

57 minutes ago, skyline069 said:

I take 450 mg Wellbutrin XR around 12 am.

 

Why are you taking Wellbutrin at 12 AM? It is an activating medication for many so am curious if it is causing issues with your sleep.

 

59 minutes ago, skyline069 said:

100 mg Seroquel XR and 40 mg Mirtazipine at around 10 pm. 

 

Entering these two medications into an interactions checker shows that there is a moderate interaction between the two. This is the output -

 

"Using QUEtiapine together with mirtazapine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."

 

I would suggest spacing the dosage of these medications at least two hours apart but to start, change the dosing time of one of them for an hour, and see how it settles for 5-7 days before moving the time between an additional hour.

 

Hopefully adjusting some of the times that you take your medication provides some relief and sets you up for some stabilization before tapering.

[skyline069]

10 minutes ago, FireflyFyte said:

 

Why are you taking Wellbutrin at 12 AM? It is an activating medication for many so am curious if it is causing issues with your sleep.

 

 

Entering these two medications into an interactions checker shows that there is a moderate interaction between the two. This is the output -

 

"Using QUEtiapine together with mirtazapine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."

 

I would suggest spacing the dosage of these medications at least two hours apart but to start, change the dosing time of one of them for an hour, and see how it settles for 5-7 days before moving the time between an additional hour.

 

Hopefully adjusting some of the times that you take your medication provides some relief and sets you up for some stabilization before tapering.

I'm sorry I think I made a mistake not being a native speaker. I meant to say that I take the Wellbutrin around noon during the day. I'm aware that it is supposed to be activating but I don't feel any effect from the medication. Like not at all. The seroquel and Mirt while not improving my mood or anything at least sedate me helping me sleep a bit. Anyway, thanks for engaging.