Coley: Severe Nausea & struggling to eat

[Coley]

Hi all,

I'm 43 and in the UK. Glad to have found this forum. I came across it as feeling desperate due to the debilitating nausea I've been experiencing, both from trying to start SSRI's and now trying to taper of them.

 

I was doing ok, mental health wise until some repeated traumas happened over the last few years (I also separated from my long term partner which added to things) and have struggled with PTSD symptoms and depression. I've experienced the side effects of starting and stopping SSRI's before so was reluctant to go on them again, but I became exhausted by the relentless PTSD symptoms which didn't subside by trying other things. So I succumbed and since November last year had been trying to go ON Escitalipram.

 

The side effects of starting Escitalipram been horrendous - namely the very high level of nausea and struggling to eat (I've also lost a lot of weight over the last 5 months and was already naturally slim).

I got up to 8mg using the drops and pretty much every step of the way I've felt very poorly with the nausea. Im not noticing any other side effects.

I've now decided to taper off as 1. the sickness side effects are too debilitating, 2. I don't want the damaging to effects of SSRI's, 3. I'm not sure how much they are helping my mental health anyway ( it's hard to tell as feeling so physically ill all the time is getting me down).

 

One week ago, I dropped from 8mg to 7mg and peak nausea has set in. 

My plan is to slowly taper, 1 mg at a time. I've only been on it 5 months but I know it's going to be hell coming off it. 

 

I guess I'm wondering what others experience of nausea, weight loss and no appetite is and any advice would be appreciated? I feel I'm doing what I can. Going for walks, getting rest. I'm trying to eat little and often even though I feel i'm forcing myself. Things like snacking on little bits like snacking on nuts, cheese, good bread, boiled eggs, bananas. 

I need to be able to function as I'm a single mum and have to work (although I'm lucky as run my own business from home which isn't too full on). The worst is having to shop and cook for the kids whilst I feel like this. Just the thought of food turns my stomach.

 

I don't know if there's anything else I can do to relieve the nausea and feel relatively normal again, so at least I can eat ok?

 

Is it worth asking the doctors to prescribe something else? An anti emetic maybe? When I was pregnant I had hyperemesis and the only antiemetic that gave me slight relief was ondansetron, but I think this interacts with SSRI's so not sure if it's a good idea?

 

To add, I started Trazadone at night a couple of months ago (100mg) mostly for sleep, to help with the panic attacks I was waking up with. I do want to continue with this as I don't seem to have any side effects with it and I am sleeping better. The dose I'm on is not the therapeutic dose for depression and anxiety, but it is definitely helping me sleep. 

I wondered if it would be a good idea to increase the Trazadone slightly whilst tapering off the Escitalipram?

 

Thanks all for your time.x

 

 

 

 

 

[Erimus]

Hello, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal.

 

Your first task is to create a drug signature, with the following:

 

• All current medication you take, the dose you take, when you started the drug, and when you made dose changes
• All current supplements you take
• An accurate history of recent drugs, taken in the last 12-24 months
• Dates for recent should be written as 7 Oct 2023, or Oct 7 2023, or early Oct 2023, or mid Oct 2023
• A history of drugs taken 24 months ago and beyond - if applicable
• Dates for historical drugs can simply be listed as start and stop years
• Please do not use 07/10/23 // 10/07/23 as this is intepreted differently around the world

 

• Please leave out symptoms and diagnoses. See my signature for example of clear and concise information.

 

• Click this link to edit your signature: Edit your signature here.

 

 

This topic is for anything relating to you, and any questions you have. Please do not start another topic.

 

We recommend tapering by no more than 10% of your CURRENT dose each month, to limit withdrawal symptoms. E.g. 10mg --> 9mg --> 8.1mg --> 7.29mg

 

All the answers you are looking for regarding tapering and antidepressant withdrawal are on this site. Please search around and continue to read as much as you can manage. Use the site search function to search for specific words or phrases, such as drugs or symptoms.

 

Here are a few of the most useful links:

 

Important topics in the Tapering forum and FAQ

 

Micro tapering

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

How to make a liquid from tablets or capsules

 

Using a scale to weigh and measure doses

 

We only recommend two supplements. Omega 3 Fish Oil and Magnesium. Both should be introduced separately and increased slowly.

 

Regards

Erimus

[Erimus]

8 hours ago, Coley said:

The side effects of starting Escitalipram been horrendous - namely the very high level of nausea and struggling to eat (I've also lost a lot of weight over the last 5 months and was already naturally slim).

I got up to 8mg using the drops and pretty much every step of the way I've felt very poorly with the nausea. Im not noticing any other side effects.

I've now decided to taper off as 1. the sickness side effects are too debilitating, 2. I don't want the damaging to effects of SSRI's, 3. I'm not sure how much they are helping my mental health anyway ( it's hard to tell as feeling so physically ill all the time is getting me down).

Try to view it as a positive that you've realised the drug isn't appropriate.

 

8 hours ago, Coley said:

One week ago, I dropped from 8mg to 7mg and peak nausea has set in. 

My plan is to slowly taper, 1 mg at a time. I've only been on it 5 months but I know it's going to be hell coming off it. 

I would suggest massively decreasing the size of your drops if a 1mg reduction is inducing severe nausea. You should probably consider micro tapering, and igven you are already on the liquid, this shouldn't be too much hassle.

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide Method of Micro-tapering

 

9 hours ago, Coley said:

I don't know if there's anything else I can do to relieve the nausea and feel relatively normal again, so at least I can eat ok?

Decreasing the size of drops, and getting off the drug, should clear up the nausea eventually.

 

9 hours ago, Coley said:

To add, I started Trazadone at night a couple of months ago (100mg) mostly for sleep, to help with the panic attacks I was waking up with. I do want to continue with this as I don't seem to have any side effects with it and I am sleeping better. The dose I'm on is not the therapeutic dose for depression and anxiety, but it is definitely helping me sleep. 

I wondered if it would be a good idea to increase the Trazadone slightly whilst tapering off the Escitalipram?

You don't want to change any other psychiatric drugs whilst you are tapering the escitalopram. Only change one variable at a time.

[Coley]

Thanks Erimus, I appreciate the advice. And yes trying to remind myself it's a positive that I've recognised I need to come off this drug.

 

I do think I need to reduce the taper, increasing by 1mg if Escitalipram slowly has been a nightmare for me. And it seems reducing by 1mg is the same. However, I really can't get my head around how to reduce/micro taper from the 1mg ( the liquid comes out as a drop and 1 tiny drop in 1 mg). 

Sorry, I'm sure the info in how to do this is on the site somewhere, but I can't find it. Can you advise how to reduce the dose of the liquid accurately, or point me in the right direction of the info?

 

Many thanks

 

[Coley]

Sorry, I meant to say - the Escitalipram liquid I have is 20mg in 1ml. I can't work out how to make this less to micro taper. Any advice appreciated 

[Erimus]

On 4/13/2024 at 11:30 AM, Coley said:

Thanks Erimus, I appreciate the advice. And yes trying to remind myself it's a positive that I've recognised I need to come off this drug.

 

I do think I need to reduce the taper, increasing by 1mg if Escitalipram slowly has been a nightmare for me. And it seems reducing by 1mg is the same. However, I really can't get my head around how to reduce/micro taper from the 1mg ( the liquid comes out as a drop and 1 tiny drop in 1 mg). 

Sorry, I'm sure the info in how to do this is on the site somewhere, but I can't find it. Can you advise how to reduce the dose of the liquid accurately, or point me in the right direction of the info?

 

Many thanks

 

Yes, you need to dilute your dose each day before you take it. Forgive me as I am not an expert on liquid tapers, but I will try my best to explain. Please add your current dose to your signature. Please read these threads in full as well as the information I have posted below. Using an oral syringe .

 

You are currently taking 7mg of Escitalopram. Your solution is 20mg/ml, so your current dose is 0.7ml? I would suggest starting with a reduction of 0.1mg, you can do these cuts quite regularly if you tolerate it okay.

 

I would suggest buying a graduated cylinder, so you can accurately measure water volumes. You may also need a few different oral syringes. Now, how to prepare your dose each day:

 

• Measure out 200ml of water using a graduated cylinder, and add this to an appropriately sized beaker.
• Measure out 1ml of your escitalopram liquid, add this to the water in the beaker.
• You now have a 20mg/200ml solution, which equals 0.1mg/ml.
• Stir, then use your variety of syringes to draw up 69ml of liquid.
• Add to a separate beaker and drink it.
• Add some more water to the beaker you've just drank from, swill it about, and drink it again. Just to make sure you're getting the full dose.

 

Once the pharmacy compounded liquid has been diluted it doesn't keep well, as far as I'm concerned, so you'll have to dispose of the rest. Depending on how much liquid you're getting on prescription each month we may need to alter the dilution ratios, otherwise you might run out.

 

 

 

Edited April 15 by Erimus

[Coley]

Thank you Erimus - this is incredibly helpful, very clear and concise.

 

A few final questions on this finally:

1. How often do you think is reasonable to attempt to reduce at a rate of 0.1mg? 

 

2. I'm nervous regarding the Escitalipram being evenly distributed in the water, particularly as I seem to be very sensitive to slight changes. Is it generally accepted that this way will result in an accurate dose each time? Do people generally consider the more stirred the better?!

 

3. I'm still feeling awful after the 1mg drop 11 days ago. I take it I'm better to wait until the withdrawal effects reduce before starting microtapering?

 

Warm wishes

 

[Erimus]

50 minutes ago, Coley said:

A few final questions on this finally:

1. How often do you think is reasonable to attempt to reduce at a rate of 0.1mg?

It's purely based on how you react to the drop. You might be able to do this every 4 days, or it might need to be slower. You'll find the speed which is best for you.

 

53 minutes ago, Coley said:

2. I'm nervous regarding the Escitalipram being evenly distributed in the water, particularly as I seem to be very sensitive to slight changes. Is it generally accepted that this way will result in an accurate dose each time? Do people generally consider the more stirred the better?!

It's the best we can do with the equipment we have. As long as you're following the same method each day it will be okay.

 

54 minutes ago, Coley said:

3. I'm still feeling awful after the 1mg drop 11 days ago. I take it I'm better to wait until the withdrawal effects reduce before starting microtapering?

Yes. Wait until you feel more stable. You'll know when you feel ready to start.

[Coley]

Amazing - thanks so much. I appreciate your very helpful replies