mayra: Reinstatement of escitalopram

[mayra]

I've been tapering 15 mg escitalopram for 3 m after taking it for 10 y. I've lowered from 15 to 10 mg without too much withdrawal symptoms, after that I've lowered the dose by around 1 mg every week. It was quite all right until one day after I took the very last dose... Panic attacks, insomnia, brain zaps, severe headache, nausea, tinnitus, very low (!) heart rate and blood pressure. After two days I was literally considering suicide. I've never experienced that much panic attacks, not even when I was told to cold turkey venlafaxine about 23 y ago, I was instead lying in bed with terrible brain zaps (withdrawal symptoms were, at least here in Sweden, basically never heard of at that time. I was fortunate and immediately saw another doctor that suggested slow tapering since he had met other patients that got severe withdrawal symptoms from venlafaxine. I was successfully off after about 6 m.  After that I've been on fl, its still oxetin for about 1 y and Cymbalta for some m. I suffered from quite a lot of withdrawal symptoms every time, but nothing like what I'm experiencing now!) I found "Surviving antidepressants", thank god, after a week and immediately reinstated 1 mg escitalopram. It was better the day after! However its still quite bad. I'm thinking I may be on a too low dose, perhaps the substance is cleared out too quick? I've always been sensitive when it comes to take meds in 24 h intervals. Already after 27 h I've started to get some (milder) withdrawal symptoms. Now to my actual question: do you think it's a good or bad idea to start taking 1 mg in the morning and add 1 mg 12 h later? I understand that it's not possible to say what certainty, I just want to get your opinion and perhaps there's someone who have tried. Thanks for a life saving forum!

Edited July 21 by Emonda
Name to title

[Catwoman73]

Hi @mayra, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes.  

 

I know Emonda has sent you a warning- if you could kindly complete your drug signature, so that we can have a snapshot picture of what medications you have taken, and where you are now, it would be a huge help to us.  To complete your signature, click the following link, fill in the box with all of your drug info (include supplements if taking any), and click save!  That's it!

 

Your Drug Signature

 

I'm sorry for what you have been through.  You are in good company here- we all have very similar stories- poorly guided tapers from well-meaning physicians who just don't know better is such a common theme. 

 

Unfortunately, it is very common for our withdrawal experiences to get worse and worse every time we come off of one of these drugs.  This has been my experience as well.  This is why very slow, hyperbolic tapering is so important.  We recommend tapering by no more than 10% of the current dose, no more frequently than every four weeks.  So as an example- 10mg- 9mg- 8.1mg- 7.3mg and so on.  This is the method I would recommend you use when you go to taper your escitalopram again, down the road.  This method of tapering does an excellent job of minimizing withdrawal symptoms.  Some have to either go slower or make smaller cuts, though, in order to have manageable withdrawal symptoms- I am in that camp.  Read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

Good for you for figuring out that you needed to reinstate!  And even better that it does seem to be working.  How long have you need taking the 1mg for now?  We strongly recommend holding your dose for AT LEAST a week (I prefer 2-4 weeks, if possible) before updosing.  The reason is that it can take quite some time to fully stabilize on any new dose.  Read more about reinstatement in the following threads:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 How long does it take to stabilize after reinstating or updosing?

 

As you stabilize, you will experience days where you feel better and days where you feel worse.  This is known as the windows and waves pattern of stabilization.  Having windows is an excellent sign of healing.  It is a good idea to start keeping a symptom journal, so you can keep track of the pattern of your windows and waves.  I track my symptoms, rate them on a scale of 1-10 every day, my foods, supplements, activities etc.  It's a great way to catch things that might be giving you grief while you stabilize.  Read more here:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

The Windows and Waves Pattern of Recovery

 

I noticed you mentioned feeling withdrawal effects after 27 hours- it is CRITICAL that you take your meds at the same time of day.  This is especially important when you are destabilized, as it doesn't take much to further destabilize you.  I find it helpful to set a reminder on my phone (because brain fog is one of my worst symptoms lol!).  

 

If, after you've held for the appropriate length of time, you wish to updose, I wouldn't jump up on the dose too quickly.  Overshooting can be even more disastrous than a dose that is too low, resulting in hypersensitivity, and significant worsening of symptoms.  To that end, I wouldn't add more than 0.5mg to what you are currently taking, if/when you decide to updose.  You can certainly split your doses up, taking 1mg, then 12 hours later taking 0.5mg if you like, but it will still be very important to take the medication on time every day.  I can't go more than an hour before or after my scheduled time without feeling the effects these days. 

 

While dealing with withdrawal symptoms, excellent self care is very important, and can help facilitate healing.  Avoid alcohol, nicotine, caffeine, recreational drugs, and any other neurologically active substance.  This means other psych drugs too- we do not recommend taking other psych drugs to deal with the withdrawal effects of psych drugs.  This can only serve to further destabilize you, and will ultimately create a situation where you have to taper (and go through withdrawal) again in the future.  Now that you are feeling a bit better, it is a good time to start working on some non-drug methods of coping with your symptoms.  I will provide you with links to a few threads on these topics, but you may find some of your own as well.  Mindfulness and distraction (for me- that means painting, dancing and swimming!) are the cornerstones of my coping mechanisms.  They have been lifesaving for me!

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

 

We only recommend two supplements here at SA- magnesium and omega-3 fatty acids.  Do be mindful though- if you choose to introduce any supplements, start with a very low dose to see how you fare.  It is quite common for those in withdrawal to develop sensitivities to medications, supplements, and even foods!  I am a prime example- magnesium has a strong paradoxical effect on me, and make me feel agitated, and if I take it at night, I wake up every 15 minutes all night long!

 

In summary- I think you've done great so far by figuring out that you need to reinstate.  It is best to hold at your current dose for at least a week (and up to 4) to allow full stabilization on this dose before making decisions about updosing.  You can absolutely split your dose if you would like, but do take your dosage(s) on time!  And someday, down the road, when you decide to try tapering again, follow a hyperbolic taper, and pay close attention to your body as you proceed.  Your body will always tell you what you need.  Work hard to find non-drug coping mechanisms that work for you.  This is important, and can help carry you through your post-drug life too!

 

Most of all, stay hopeful.  We are all healing, all the time, even on days when we don't feel like it will ever end.  Trust your body- it knows what to do!

 

This is your introduction topic- each member gets one intro topic.  Please post questions and updates here, but do feel free to explore the forum and engage with other members!  It's much easier to get through this when you know you're not alone!