I2024 - tapering off 40mg of lexapro

[I2024]

I am new to this forum. I am tapering off 40mg of lexapro after many years (no longer effective) and am experiencing significant withdrawal symptoms. Has anyone else been on a high dose and for a long period of time? 
 

Edited July 17 by Emonda
Name to title

[I2024]

I note literature and guidelines around tapering off doses of lexapro- which has been hugely helpful so far. However these are usually 20mg or under so I do wonder if this is the same for higher doses too 40mg, whether withdrawal symptoms are same/worse, and whether there is anything else that should be taken into consideration. 
 

[Emonda]

Welcome @I2024

 

On 7/17/2024 at 8:02 PM, I2024 said:

I am tapering off 40mg of lexapro after many years (no longer effective) and am experiencing significant withdrawal symptoms.

 

Slow is the way to go when tapering:

 

Why taper by 10% of my dosage? The reductions should get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc. This process involves a degree of trial and error, as there is no way of predicting how an individual will respond. Importantly, if you develop unpleasant side effects from tapering, halt the taper, give yourself time to settle, and once stable, taper more slowly and by smaller amounts moving forward. The experience of others suggests that the lower you go in dose, the slower you need to go with tapering.

Those that taper too quickly often develop very unpleasant withdrawal symptoms. This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience. The point of providing this list is not to scare you but to ensure your eyes are open to the warning signs as you taper.

Some people find tapering by smaller weekly amounts more tolerable. You can read more about this approach here: The Brassmonkey Slide Method of Micro-tapering

Recovery from ADs and tapering is not linear. There are good days and not-so-good days/weeks/months. This is referred to as the Windows and waves pattern of stabilization.

 

The following general links are worth reading:

Emotional Spirals

Non-drug coping strategies

Melatonin for sleep

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium and Omega-3 fatty acids (fish oil)

Avoid alcohol.

Don't change the manufacturer of your AD.

Once again, welcome to S.A.

Emonda

[I2024]

Thank you Emonda for your reply. I have been working my way through these links and have purchased those two supplements too. 
I am early on in the tapering process and during my first drop the worst symptoms seemed to last 10 days however this second drop seems to be lasting a lot longer, feels worse and more intense as the days go on. How do you know how much you can tolerate? Is it expected to feel such effects so early on in tapering (only dropped lexapro twice 2.5mg + 2.5mg) and can a rhythm/pattern be found in terms of length, type of symptoms in the future. What I feel now/so far- can I expect this will the same next time or is this just something that is a process and we need to learn to sit with the uncertainty? Thank you again for your help. 

[Emonda]

23 hours ago, I2024 said:

this second drop seems to be lasting a lot longer, feels worse and more intense as the days go on.

 

That might be a sign to hold longer. Once stable, perhaps the next reductions should be smaller. Have a read of the Brassmonkey slide link.

 

23 hours ago, I2024 said:

or is this just something that is a process and we need to learn to sit with the uncertainty?

 

It's just a matter of finding a reduction you can tolerate. I couldn't handle 10% in one go. The Brassmonkey slide works for me. I've tried amounts between 2% and 3% per drop. Currently "experimenting" at 2.5%.

 

It's not a race...slow is the way to go.

[I2024]

Thank you, I think this will be the way to go. How long would you tolerate ‘super severe’ withdrawal symptoms. I have a very good tolerance but this has become nearly unbearable/unmanageable in terms of feeling so incredibly low, agitated, irritated, panicky, my heart feels like it wants to jump out of my skin and I just don’t want to get up right now and do the day. Is it better to persevere as this is now day 20 since this drop? I’m hoping it will settle soon and then I’ll hold for a while. Otherwise I might have to reinstate the previous dose? 

[I2024]

Another thought… I am thinking of whether it is better to continue this process as an inpatient versus continuing this at home (finding symptoms very tricky to manage). Has anyone had an inpatient/outpatient/home experience and what are your thoughts….

Thank you! 

[I2024]

Would anyone have any advice that may be helpful for where I am in this process at the moment (see above posts)? - I would really appreciate it. Thank you!

[Emonda]

On 7/24/2024 at 8:06 PM, I2024 said:

I am thinking of whether it is better to continue this process as an inpatient versus continuing this at home

 

Do you mean going to a medical facility? They'd likely give you more drugs. I'm not aware of any drugs that resolve WD symptoms.

 

Personally, I set a line in the sand at the start of my taper when I was finding my way through this process. I felt dreadful at one stage (more than one stage, really 🙃), so I set a time limit of three weeks. If I still felt fragile after three weeks, I was going to increase to the previous dose (no more than a 10% increase). Somehow I held on on all bar one occasion.

 

I hope this helps.

[I2024]

Thank you Emonda, I have heard of people withdrawing from antidepressants in the hospital setting (I’m aware not an ideal solution) but perhaps WD symptoms can be managed better (even if with other meds temporarily) not sure what I think here- both pros/cons. 
 

I think drawing a line in the sand and setting parameters is a good idea. I guess I’m trying to keep pushing through like you mentioned, I’ve made it this far and I do feel that maybe the acute WD symptoms may be starting to pass a teeny tiny bit. I am at day 29 of lexapro drop 2 (35mg) but find I have this 24/7 fluctuating level of agitation. It’s very bothersome and difficult to function at a number of levels with it. I just don’t feel like me and I’m concerned this will leak into every other area of my life. 
 

I don’t know whether I should just return to my full dose of lexapro 40mg. Quality of life in both cases were not wonderful but this makes you question- how much can one person tolerate and keep managing….

 

Any thoughts or advice here would be thoroughly helpful. Thank you.  

[Ariel]

Hi @I2024

Welcome to SA. Sorry for what has brought you here and glad you've found us! 

 

Perhaps you know this already, and just in case it bears repeating -- lexapro/escitalopram is one of the most potent SSRIs out there. 40mg is a massive dose! 

You might want to check out / review our help topic, full of practical information and  Tips for tapering off escitalopram

 

What you've got going for you is that, based on your drug signature, it looks like you're starting your taper from a place of stability. By this I mean that it seems you've been on a steady dose of 40mg escitalopram for a number of years, without any changes and without combining this with any other drugs. Is that correct? 

If that is indeed the case, this is in your favor. It's highly recommended to be stable prior to beginning a taper, as this tends to make things more manageable and helps with clarity in tracking symptoms as they arise. 

 

Since you have already made a few cuts and are experiencing such intense WD symptoms, the general recommendation at this point would be to hold your current dose of 35mg for an extended period of time to re-establish stability, OR make a very slight updose (but definitely not returning to 40mg, and not returning to 37.5mg either). I'm not a mod, and if you are interested in the possibility of a tiny updose (something like in the 0.1-0.5mg range, probably), please check with a mod on details of dosage before you proceed. That being said, if it were me, I would hold steady at 35mg until things settle down. The reason for this is that it's really best to avoid jumping around in dosage because this further destabilizes our systems. As mentioned before, you've got the advantage of starting your taper from a place of stability; the cuts you have made are de facto destabilizing (as is any taper), and it would be a pity to exacerbate this. 

 

To learn more about the art/rationale of reinstatement/updosing, etc., see this help topic on Reinstatement.

 

In regards to preserving stability and preventing unnecessary further destabilizing/complicating interventions, it's not recommended to introduce new psych drugs in order to manage WD symptoms from original psych drug(s). I mention this because your drug signature includes this: Have been given temazapam and diazapam to use occasionally- only if can’t manage severe withdrawal moments. If it were me, I would steer clear of these altogether (same goes for any other benzodiazepines and any other psych drugs). It's just not worth it to mess around with additional psych drugs, the effects of which are highly unpredictable given a destabilized, hypersensitive system. You are actually in a really good position given that you're not polydrugged, you've only got escitalopram to come off of -- and again, you're starting from a place of stability! These two aspects are to your advantage. Protect your advantage and make it easier on yourself by keeping things as simple as possible. 

 

In my (non-moderator) opinion, it would be good to hold for now at your current dose of 35mg. You may need a longer hold, that's okay, that's quite common in the tapering process. While you're holding, you can use this time to gather data, familiarize yourself with SA and the many resources here, and educate yourself further about how best to come off of escitalopram. You're two cuts in to your taper and your body has already provided you with some very valuable information, namely that WD symptoms have developed, meaning that your body's asking to go slower. It's actually good news that you're getting this message so early in the process! Some people taper for a lot longer and make many cuts, not feeling many negative effects, and then suddenly everything catches up to them and it's much harder to stabilize. Moreover, escitalopram is notorious for a phenomenon known as delayed-onset withdrawal, where one feels fine for a while as if everything were hunky-dory, and then WD sets in with a vengeance. That's a lot harder to deal with when one is far in to a taper. So again, you're in a pretty good position receiving the memo so soon in the game!

 

Now that you've got the memo that your body's very sensitive to cuts, after an extended hold, you can consider resuming your taper at a gentler rate, for example a more gradual taper such as the Brassmonkey Slide (which Emonda mentioned) or other custom microtaper. It's all about listening to your body and adapting your taper rate based on symptom data/feedback. Are you already keeping a symptoms journal with daily notes to help you track patterns/process?

 

About this --

 

On 7/24/2024 at 12:06 PM, I2024 said:

Another thought… I am thinking of whether it is better to continue this process as an inpatient versus continuing this at home (finding symptoms very tricky to manage). Has anyone had an inpatient/outpatient/home experience and what are your thoughts….

 

Frankly, unless you uproot and move into an inpatient facility for years to come, I don't see how this would be possible. A gentle, responsible, harm-reduction, hyperbolic taper off of 40mg escitalopram will take years to complete. That's the truth of it (and don't let that scare you; ideally, when conducted with appropriate care, the point of a years-long taper is that it allow one to live one's life more or less normally along the way; so it's not necessarily years on end of acute WD symptoms/suffering, the objective is precisely the contrary). Even if one were to desire living at a hospital for years at a time while tapering, I don't know of any facilities that offer this as a possibility -- not least because I don't know of any established hospitals that acknowledge/recognize the risks of withdrawal and apply principles of harm-reduction hyperbolic tapering to help people gradually, responsibly come off psych drugs. Doctors and psychiatrists don't know what they're doing, ignorance abounds, that's how so many of us get injured and that's why SA exists. In summary, if you want to get off of psych drugs, if you want to come off of escitalopram, inpatient is not the way to go. To a hammer everything looks like a nail; the medical establishment is all about prescribing more and more drugs at higher and higher doses, adding to the mix (the so-called drug carousel), that's what they do. Deprescribing is not their forte (to say the very least), let alone proper deprescribing.

 

Speaking of deprescribing, you might want to pick up a copy of The Maudsley Deprescribing Guidelines, co-authored by withdrawal expert psychiatrist (and fellow psych drug taper-er) Dr. Mark Horowitz, who also offers academic consultations if you'd like to speak with a professional specialist to get some in-depth input as to your case. 

 

For now, hold where you're at and don't make any changes. If you'd like to explore the possibility of a very slight updose, consult with a moderator (or someone like Dr. Mark Horowitz) first. 

 

I'm sorry you're dealing with withdrawal symptoms. If you go back to Emonda's welcome post you'll see some useful links to SA help topics on non-drug coping strategies, as well as other excellent information (e.g. the Windows and Waves topic is a very important one to study). There are a lot of resources here, and there can be a bit of a learning curve in the beginning, so be patient with the process, and be gentle with yourself along the way. When I'm feeling challenged it always helps me to remember that many people before me have successfully come off of psych drugs and healed and recovered (check out success stories in the recovery forum), and so the evidence points to a high probability that I will also heal and recover. In the meantime, we've got the gift of SA community, peer support, and myriad invaluable resources to see us through. 

 

As mentioned above, I believe there is strong basis for hope in your situation with several encouraging factors to set you up for success! To recap a few:

- you started your taper from a place of stability 

- you found and joined SA very early in your taper, so you're primed to get the best guidance from the get-go

- you are only on one single psych drug (NOT polydrugged)

- your drug history (according to your signature) is pretty straightforward

- you're experiencing WD symptoms very early on, meaning you receive crucial data from the beginning of the process and can adapt as needed moving forward

- and I'm sure there are more that I'm not aware of -- feel free to continue listing the advantages you've got! 

 

Best of luck to you on your journey, in solidarity and support,

Ariel

[Ariel]

Hello again @I2024

 

Because you mention this in your drug signature: Tapering because drug not longer effective. 

And because you have a history of regularly increasing dosage from 10mg (2011) -> 40mg (2019) --

I'm wondering whether you're dealing with tolerance, or as it's also known around these parts, poop-out -- ?

 

There are a few ways to determine whether you're in poop-out. Check out the help topics linked below for more information. 

If you are indeed in poop-out, the embodied experience of tapering and WD symptoms can present a bit differently than otherwise. 

The valuable intel in these help topics will provide an introductory overview (all part of the SA resources education bundle!), read on to learn more.

 

Tachyphylaxis, Reaching Tolerance, or as It's Lovingly Known, "Poop-Out"

 

Tolerance or "poop-out" or Tachyphylaxis

 

[Emonda]

On 7/28/2024 at 7:18 PM, I2024 said:

I have heard of people withdrawing from antidepressants in the hospital setting (I’m aware not an ideal solution) but perhaps WD symptoms can be managed better (even if with other meds temporarily) not sure what I think here- both pros/cons. 

 

What Ariel said 👍. This is a lengthy process, so a hospital setting is not really a solution, and they'll just give you more drugs.

 

On 7/28/2024 at 7:18 PM, I2024 said:

feel that maybe the acute WD symptoms may be starting to pass a teeny tiny bit.

 

Excellent

 

On 7/28/2024 at 7:18 PM, I2024 said:

I don’t know whether I should just return to my full dose of lexapro 40mg.

 

I'm with Ariel. If you can hold a little longer given things have improved a little, that's ideal.

 

Once you are stable for a month, you might consider a much smaller reduction next time around. My reductions are generally around 2% per drop.

 

On 7/28/2024 at 9:00 PM, Ariel said:

If it were me, I would steer clear of these altogether

 

100%!

 

Thanks for jumping in Ariel 😊