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DarkSkies: Liquid Escitalopram taper in Germany


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Hi everyone! I’ve been keeping an eye on this forum for over a year now, today I decided to finally write my first post.

 

To keep a long story short, I started taking Escitalopram (10 mg) after struggling with some (unrelated) health issues back in 2021. When I tried to discontinue my medication a year later (2022), I started experiencing unbearable withdrawal symptoms and had to reinstate back to 1 mg. I stabilised after a couple of months. 

 

Due to the fact that I didn’t have access to the liquid version of Escitalopram, 0.56 mg was the lowest dose I could taper down to via crushing the pills and weighing them. After that, I discontinued (2023) and hoped for the best. 

 

It’s been 11 months now since my last dose and I’m still experiencing debilitating side effects from discontinuing. The worst of them started about 5 or 6 months since I stopped. I’m now considering reinstating back to an even smaller dose than the one I quit, probably 0.40 mg.

 

I’m currently live in Germany, where liquid Escitalopram is available. But I’m unsure how to broach this topic with a german psychiatrist, since I’m not originally from here and my previous prescriptions were not issued here. My origin country simply doesn’t have the liquid version of this medication, otherwise I would have simply gone back to my previous psychiatrist.

 

If there’s anyone else here in Germany who can offer me some advice or insight, I would be deeply grateful. What would be the best way to approach this? 

 

Big hello to everyone here and thanks for reading.

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

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  • Erimus changed the title to DarkSkies: Liquid Escitalopram taper in Germany
  • Moderator

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.

 

Sorry you have suffered so much, despite tapering cautiously. What symptoms are you currently struggling with? At 11 months off reinstatement is a gamble, none of us can predict how you will react.

 

If you do decide to reinstate I would be considering a start dose of 0.1mg, we often find a dose much smaller than expected is enough to settle the nervous system. It's better to start small and work your way up, if necessary, rather than jump in to high.

 

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?

 

How to make a liquid from tablets or capsules

 

Using a scale to weigh and measure doses

 

--------From the Symptoms and Self-Care Forums--------
 
What is withdrawal syndrome?
 
About reinstating and stabilizing to reduce withdrawal symptoms
 
The Windows and Waves Pattern of Stabilization

 

Hypersensitivity and Kindling

 

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

 

Regards

Erimus

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment

 

Thank you Erimus for your reply.

 

I struggle the most with neuropathy and paresthesia in my extremities. Also GI issues: constant stomach pain and indigestion from every food item imaginable. In my case, depending on what I eat, my nerve pain increases or decreases from moderate to severe. These are by far the worst two symptoms. Insomnia was also a major issue for many months, but it improved over time.

 

My practical question is, would I be able to consistently create a 0.1 mg dosage using escitalopram liquid? This is a very small dosage. My prescription would be Cipralex 20 mg/ml, where 1ml = 20mg, and 1 drop = 1 mg. I was thinking I would mix one drop in water, and then only drink 1/10 of that water.

 

I know the advice I read here is to not use drops as measuring unit, because they’re unreliable in terms of dosage. What would be a better way to approach this? 

 

If my calculations are correct, 1ml = 20mg and 0.1ml = 2mg. And then I could further dilute the 2mg in water and measure out the 0.1 mg dosage. 0.1 ml is the lowest dosage I could measure using a 0.5 ml syringe. Is this correct? And probably after 3 or 4 days I‘d have to throw away most of this suspension and make a new one.

 

Is this the way people usually measure their liquid escitalopram/ lexapro dosage? Am I missing something? I see sometimes in their signatures that they reduce in very small increments (ex: from 2.4 mg to 2.2 mg), but I don’t understand how they achieve such precision.

 

Many thanks,

DarkSkies

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

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  • Moderator
Posted (edited)
3 hours ago, DarkSkies said:

My practical question is, would I be able to consistently create a 0.1 mg dosage using escitalopram liquid? This is a very small dosage. My prescription would be Cipralex 20 mg/ml, where 1ml = 20mg, and 1 drop = 1 mg. I was thinking I would mix one drop in water, and then only drink 1/10 of that water.

Measure out 1ml of your solution, and add it to 200ml of water. That gives you 20mg/200ml, which equals 0.1mg/ml. Take 1ml.

 

3 hours ago, DarkSkies said:

And probably after 3 or 4 days I‘d have to throw away most of this suspension and make a new one.

If you're diluting a compounded solution you will need to prepare your dose every day, once you have added water to these solutions they do not keep well.

 

Alternatively you can ask to be prescribed solid tablets and create your own suspension, which would keep for 4-5 days in the fridge. See: How to make a liquid from tablets or capsules

Edited by Erimus

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment

Hi Erismus

 

Thank you for your advice, much appreciated.

 

I made one attempt last year at creating my own suspension using the instructions on this forum, but it didn’t work. Maybe it was the particular brand of pills I had, or my lack of experience, but it backfired on me and I was really ill for a month after. I‘ve updated my signature with this info, sorry I haven’t mentioned it earlier.

 

I managed to get a prescription for escitalopram liquid and 0.5 syringes. I did the math and I could even create a 0.05mg dose. Considering the risk of kindling (it’s already been 11 months since I stopped), would 0.05mg be a better reinstatement dose instead of 0.1mg? And as long I don’t have an initial adverse reaction, I could always increase it later.

 

I honestly have no idea what to expect. Would the body even register such a small dose? I will of course track my symptoms.
 

Thank you for the tip about preparing the solution everyday, I definitely missed that! I also read about having to change the solution bottle every 8 weeks after opening it, even if I don’t finish it.

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

Link to comment
  • Moderator
3 hours ago, DarkSkies said:

I managed to get a prescription for escitalopram liquid and 0.5 syringes. I did the math and I could even create a 0.05mg dose. Considering the risk of kindling (it’s already been 11 months since I stopped), would 0.05mg be a better reinstatement dose instead of 0.1mg? And as long I don’t have an initial adverse reaction, I could always increase it later.

Either 0.05mg or 0.1mg will be fine to test the waters.

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment
  • 2 weeks later...

Just wanted to give an update. I reinstated at 0.05 mg, 10 days ago.

 

I had no immediate adverse reaction to it. If anything it made me feel sedated and calm. It reduced my withdrawal symptoms by about 35%, which I was very grateful for. Most importantly, it reduced my nerve pain and improved my digestion.

 

But after the 4th day, things got more complicated. I started developing some side effects, like increased heart rate, muscle twitching, rigid muscles, overheating, shivering. I had increased anxiety on the 8th and 9th day, for 2h after taking my dose. Some of these side effects have already subsided, but not all of them.

 

The 6th day was by far the best one. There was one full afternoon where I felt almost normal. The pain and discomfort subsided, I felt comfortable and relaxed. I went on a walk, played video games and started reading a book.


But after the 9th day most the progress abruptly disappeared. The nerve pain returned as strong as ever, the constant parestesia, difficulty sleeping, plus all the new symptoms from the reinstatement that I’ve now collected, like muscle twitching. I’d say I went from feeling 30% better to only 5%.


My PMS usually makes my symptoms much worse, and it is that time of the month. I’m wondering if that suddenly halted my progress.


I don’t understand what this means. Did my reinstatement work? Did it not work? Should I give some more time? I’d be grateful for any insights or advice. It’s been a nerve raking experience, waiting every day to see if it worked or not, second guessing every body sensation, every symptom.

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

Link to comment
  • Moderator
3 hours ago, DarkSkies said:

Just wanted to give an update. I reinstated at 0.05 mg, 10 days ago.

 

I had no immediate adverse reaction to it. If anything it made me feel sedated and calm. It reduced my withdrawal symptoms by about 35%, which I was very grateful for. Most importantly, it reduced my nerve pain and improved my digestion.

 

But after the 4th day, things got more complicated. I started developing some side effects, like increased heart rate, muscle twitching, rigid muscles, overheating, shivering. I had increased anxiety on the 8th and 9th day, for 2h after taking my dose. Some of these side effects have already subsided, but not all of them.

 

The 6th day was by far the best one. There was one full afternoon where I felt almost normal. The pain and discomfort subsided, I felt comfortable and relaxed. I went on a walk, played video games and started reading a book.


But after the 9th day most the progress abruptly disappeared. The nerve pain returned as strong as ever, the constant parestesia, difficulty sleeping, plus all the new symptoms from the reinstatement that I’ve now collected, like muscle twitching. I’d say I went from feeling 30% better to only 5%.


My PMS usually makes my symptoms much worse, and it is that time of the month. I’m wondering if that suddenly halted my progress.


I don’t understand what this means. Did my reinstatement work? Did it not work? Should I give some more time? I’d be grateful for any insights or advice. It’s been a nerve raking experience, waiting every day to see if it worked or not, second guessing every body sensation, every symptom.

After reinstatement your nervous system can start to rapidly cycle through symptoms as it begins to adjust to the reintroduction of the drug. In my opinion symptoms during reinstatement are not always a negative thing, it is just the brain reacting after a lot of struggle without the drug.

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment

Unfortunately I had a severe reaction an hour after typing my last message. 
 

My body started overheating and I got nauseous. I now have constant hot flashes of varying degrees of intensity, they’re very uncomfortable. Too strong for me to sleep.

 

This is such a frightening experience and I sadly think my reinstatement stops here. The thought that I could be stuck with these hot flashes forever is overwhelming.

 

 

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

Link to comment
  • Moderator
Posted (edited)
14 hours ago, DarkSkies said:

My PMS usually makes my symptoms much worse, and it is that time of the month.

 

Edited by Erimus

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment

I’m not sure I understand, are you suggesting that I continue?

 

I’ve never felt anything like this before, during my withdrawal or PMS, it was severe. I risk completely losing my ability to sleep if these hot flashes become permanent.

 

 

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

Link to comment

Or perhaps I could try reducing to an even lower dosage? Maybe something like 0.02? 

 

I’m honestly not sure what to do. 

2021 September - start taking escitalopram 10mg; 1 year

2022 late August 

- first attempt to discontinue escitalopram 10mg, after cold switch to Prozac gave me SI

- tried to switch back to escitalopram 10mg after 10 days, but it gave extreme adverse reactions; psychiatrist doesn’t know what to do, so I cold turkey, no tapering

2022 December - discover the SA forum, reinstate 1 mg escitalopram; succeed, partially stabilised after 5 months 

2023 February - attempt to switch to homemade solution instead of crushing and weighing pills; attempt failed, made me feel much worse 

2023 March - reduced dosage to 0.75 mg; taper down to 0.56 mg until 2023 May 

19 July 2023 - second attempt at discontinuing escitalopram; 11 months

April 2024 - take Dong Quai and Chaste Berry supplement for 3 days; withdrawal symptoms intensify, constant GI issues ever since
15 June 2024 - reinstate 0.05 mg using escitalopram liquid solution; failed; 80% of protracted withdrawal symptoms disappeared within 10 days, but had a strong adverse reaction (burning skin); 13 days

27 June 2024 - third and last attempt at discontinuing escitalopram

Link to comment
  • Moderator
4 hours ago, DarkSkies said:

Or perhaps I could try reducing to an even lower dosage? Maybe something like 0.02? 

 

I’m honestly not sure what to do. 

I wouldn't bother with a smaller dose. Just see how things go over the next few days. If you can't tolerate the symptoms any longer stopping is fine.

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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