MarcinJ: Escitalopram withdrawal and reinstitution

[MarcinJ]

Hello,

I was on Escitalopram for 6 months. After seeing my doctor we decided that I didn't have any symptoms for anxiety/ depression any longer, so my doctor advised me to wean off 25 % monthly until I was totally off.

The drug gave me a lot of side effects - nausea, headaches , tingling sensation etc. They subsided a little , but still I felt them all the time., however I think it healed my original condition. 

I felt withdrawal effects each time I reduced by 25% for sure, but I guess the worst was the last dose 2,5 mg and then zero.

6 weeks later I began to feel awful (fatigue, electricity in my head, on my face, all over the body) I called my doctor and she advised me to go back on 5mg for 3 months and then try to taper, which I did 4 days ago. I would say it made a difference, but I'm still getting massive side effects of the drug, including a lot of tension and nervousness, which is something new.

Today she advised me to go to to 3 mg (liquid)

 

What do you think I should do? Stay on 5mg for 3 months or go down to 3mg (liquid)? 

Thank you for your help.

Marcin, Poland

 

Edited August 16 by Emonda
Name to title

[Catwoman73]

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

 

If you could kindly create a drug signature for your posts, we would greatly appreciate it.  This allows us to see your drug history quickly and easily when visiting your thread.  To do this, just click on the following link, fill in the box with drug names, dates, dosages and any other relevant info, and click Save.  That's it!  Your drug signature should be updated as you make changes down the road.  You can have a look at my signature at the bottom of this post to see the general format. 

 

Your Drug Signature

 

I'm so sorry for your struggles.  Unfortunately, you were given bad advice by your doctor.  This is a common occurrence around here.  Most doctors don't have any idea how to properly help patients taper from these medications.  Here at SA, we recommend tapering by no more than 10% of your current dose, no more often than every 4 weeks.  This is known as hyperbolic tapering, and is designed to release the receptors in the brain at a consistent and slow rate, thereby reducing withdrawal symptoms.  You can read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

Your doctor did do the right thing by reinstating you.  Personally, I would have chosen a lower dose to start, as there is some risk of developing hypersensitivity when reinstating on too high a dose.  This is likely why you are experiencing tension and nervousness since reinstating.  Again, your doctor is right to decrease your dose if you are experiencing these symptoms.  You can read more about hypersensitivity and it's more serious cousin, kindling, in the following link:

 

Hypersensitivity and Kindling

 

If you have only been on the 5mg for a few days, you are perfectly safe to switch to 3mg at this time.  I think, given the symptoms you are describing, it is probably in your best interest to do this, as a hypersensitivity reaction can continue to worsen over time if you stay on the same dose.  The idea with reinstatement is to find the lowest possible dose that helps relieve your symptoms, and then hold at that dose for weeks to months to allow your body to fully stabilize again.  You can read more about reinstatement here:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

 

I want to emphasize that reinstatement is not a magic bullet, and often does not work right away.  It doesn't work at all for some, but in your case, I really do think it is worth trying.  You will continue to experience symptoms for a while- think weeks to months- while your brain and body try to find stability again. 

 

You may benefit from starting a symptom journal.  I keep one, and each day, I rank my different symptoms on a scale of 1-10.  This is important to do because when experiencing withdrawal symptoms, it can be extremely hard to distinguish from one day to the next whether or not you are feeling better.  Everything does start to blend together after a while.  If you have a written record, it can make it much easier to see if you are getting better, worse, or feeling the same.  You can use the following list of typical withdrawal symptoms as a template if you wish. 

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

As you proceed through your healing journey, you will notice that some days/weeks feel better than others.  This is normal, and is a good sign that healing is occurring.  We call this the windows and waves pattern of stabilization.  You can read more here:

 

Windows and waves pattern of stabilization

 

In order to help facilitate healing, it is best to eat a whole foods, balanced diet, stay adequately hydrated, prioritize rest/sleep, get gentle exercise, and avoid neurologically active substances, such as caffeine, nicotine, alcohol and recreational drugs.  It is also important to avoid adding any further psychiatric medications into the mix to try to reduce the symptoms caused by the first drug.  This is important for two reasons- one, the results are unpredictable, and may make things worse rather than better.  And two- adding another medication just creates a situation where you will need to taper off of another drug down the road, thereby prolonging your withdrawal/tapering journey. 

 

We only recommend two supplements on SA- magnesium and omega-3 fatty acids.  Do note though, it is very common for a person with a destabilized nervous system to develop hypersensitivities to all sorts of things, including other medications, supplements, and even foods!  If you choose to add anything new to the mix, including our recommended supplements, start with a low dose to see how you do, and slowly increase from there.  I am a prime example of someone who has developed hypersensitivites- I can't take magnesium, because it has a paradoxical effect on me, causing insomnia and brain zaps! 

 

While your body and brain is trying to stabilize themselves, it's a good idea to start practicing some non-drug coping mechanisms to help get you through the days when symptoms are flaring up.  We have a bunch of threads on non-drug coping mechanisms that I will link below.  You may find some of your own, too.  In addition to mindfulness, meditation, and distraction, I really enjoy the calming effects of swimming and engaging in artistic endeavours.  

 

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

 

In summary, given that you are experiencing new onset of nervousness and tension since reinstating, dropping to 3mg at this time is likely a good move.  Start tracking your symptoms in a journal- this will allow you to see if you are feeling better or worse with each subsequent move you make.  It may also help you identify potential symptom triggers, which in turn will make your journey run more smoothly.  Once you find an ideal dose that reduces your withdrawal symptoms, but does not cause you to feel so activated, you will likely have to hold there for many weeks to months to allow for stabilization to occur.  When you resume tapering, do so by decreasing hyperbolically for your best chance of getting through it with minimal withdrawal symptoms.  Do keep us posted, and we are more than happy to provide you with information to help you make decisions on the next best move, should the drop to 3mg not help.

 

This is your introduction topic.  Each member gets one intro topic- please post updates, questions and concerns here.  But don't hesitate to explore the rest of the forum- there is lots of good information here!  And if you are up to it, feel free to engage with other members by dropping a comment and/or a word of support on the intro threads of others.  Finding stability after our lives have been turned upside down by these drugs can be lonely- it can be very helpful to have a community of people who understand exactly what you are going through by your side. 

 

Wishing you peace and healing... let us know how things are going! ❤️‍🩹

[MarcinJ]

Thank you so much for your help. It's so heartening to read your post. 

Could you also recommend any drugs to cope with insomnia , that work particularly well in the healing process? (I don't think my doctor will be reluctant to prescribe them) I'm pretty good at breathing techniques, it might help, but I'm afraid it might be far too little, though. 

Love,

Marcin