Dutchlady: Withdrawal after strong interaction Escitalopram and omeprazole

[Dutchlady]

Hi everyone,

 

I would like the share my story with you. And I hope you can give me some advice.

 

I have been on 10 mg Escitalopram voor more than six years en it has always worked well for me. It has helped me to heal from a burnout I had in 2017 and I have never had the intention to stop. I also used mirtazapine 7,5mg between 2018 and 2020 and succesvolley stopped using that in 2020 (had a few nights of nausea but that was it). So it was just the 10 mg Escitalopram for years. All was well.

 

Last year (2023) I got a very bad stomic flu (most likely Rota-virus that hit a bit harder than usual, because of a weakened immune system after 2 winters of covid-lockdown). This caused me to get an inflammation in my oesophagus (diagnosed during a endoscopy in my stomach). I was therefore prescribed omeprazol. I have been on this medication for about a year, the last half of 2023 I was on a full dosis of 40 mg omeprazol. This eventually cured the inflammation and I came off omeprazole in January 2024 in a few steps. I never liked this medication, as it made me feel tired and I suffered from some disrupted sleep now and then.

 

After stopping the omeprazol, I was quite well for a while, but about six weeks after quitting omeprazole I became very very tired, sweaty, and eventually had almost 2 weeks of diarrhea. I then just thought this was a stomach flu or so, althought it felt a bit weird. After that I continued to have en very irritable bowel. I also got very vivid dreams and nghtmares en I was often sweating during the nights. I also had an eyelash dat was shaking the whole time en the nerves and muscles In my arms, neck and back became very sensitive, causing me to have a lot of back pain, which I constantly tried to ease by going to massages and my chiropractor.

 

I also noticed that my PMS before my periods was really worse for two cycles long. My breasts were extremely painful the week before I got my period, which is something I otherwise never had.

 

By the end of May, I was in London and I started to feel really ill. Super tired, flu like symptoms, bad sleep, sweathy during the nights, nausea, painfull limbs. I kind of felt like the way I felt when I just started my Escitalopram and went through the first side effects of this medication, so I decided to contact my psychiatrist.

 

It was then that I discovered that Escitalopram en omeprazol have a very strong interaction. By using omeprazol, plasma levels of Escitalopram go up by 100%! This means that I have been on a much higher dosis of Escitalopram (20mg instead of 10mg) during the time I was on omeprazol, quite a long time! And after quitting die omeprazol, plasma levels quickly went back to 10 mg, my original dose. You can find the scientific research on this interaction here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297217/#:~:text=Because citalopram%2C escitalopram%2C and sertraline,by concomitant treatment with PPIs

 

So basically, all the time during the spring I had been suffering from withdrawal! After finding out about this, I decided to increase my Escitalopram to 12,5 mg and then to 15mg (this was June). I thought this helped for a while, but the nausea, backpains and irritatable bowel continued to pop up (PMS issues went away though, no painfull breasts anymore). I had a colonoscopy in June; nothing was found there.

 

Over de summer I had a family holiday and was quite ok for a few weeks. But after I came back home, all the symptoms came back worse than ever.

 

Since then I've basically been really ill and I have partially been staying at my parents house. I still suffer with extreme fatique, nausea, lack of appetite, early wakings, sweating, pains in my legs and arms and lately I also suffered more from psychological symptoms, like being depressed, anxious and worrying all the time. I also find it very hard to concentrate and I keep googling about all this. I have also lost quite a lot of weight.

 

My psychiatrist has prescribed me 7,5 mg mirtazapine again, to help me fall asleep a little easier and to help me to regain my appetite. I feel the effect a little bit but not in a major way (started last week, so perhaps I should give it a bit more time).

 

Actually I just wanna go a bit more up, to 20 mg of Escitalopram because I'm done with this, but my psychiatrist first wants to check my plasma levels, while I'm on 15mg, so I have to wait for that blood test. And I'm also a little scared: What If going up to 20 mg will also not help?

 

I just feel very frustrated about all this. I was fine for many years on 10 mg, never had the intention to stop (I halved my dose once for about a month in 2021 but quickly got diarrhea and bad moods, so went back on 10mg and fully accepted that). But now I have been thwrown into a withdrawal process without even knowing that I was going up and down dosises due to the omeprazole.

 

Do you maybe have any thoughts or wisdom that you can share with me? And what are your experiences with reinstating to the original dose? Please know that it's not my intention to taper further down. I just want to stabalize again. I am not anti antidepressants, so comments like "just get rid of it altogether" will definitely not help me. 

 

Many Thanks in advance!

Dutch lady




 

[LotusRising]

@Dutchlady

 

Welcome to SA,

 

This is a site dedicated to helping individuals taper off medication. 

 

But for stabilization, we often recommend holding your dose. It sounds like you've been up and down (unintentionally) and this can be confusing for your nervous system. Are you currently at 15mg still?

 

Did anything improve since adding mirtazapine?

 

 

[Dutchlady]

Thank you for your reply! After adding mirtazapine, falling asleep got a little better, the pains in my limbs decreased and my bowel movements also calmed down a little bit, although there was one day with a very overactive bowel en there was a bit of dizyness in the beginning. Moments of anxiety remained.

 

I updosed my dose of Escitalopram to 20mg last weekend. Now struggling with some annoying side effects again, like nausea, fatigue and since a day or two an irritable bowel again. This is a bit frustrating as my bowels had actually calmed down a little bit.

 

Anyone else had experience with side effects during updosing and/or stabilizing after WD?

No waves of anxiety anymore, altough I still feel a bit shaky now and then. Sleep seems to improve a little bit. No very early wakings over the last three nights. But very nauseous and sweathy in the morning. 

 

Curious to hear your thoughts and/or advice

[Dutchlady]

Oh and there have also been moments of severe headache some evenings over the last week, but I believe this can be a common side effect after updosing Escitalopram? The nausea is the worst and most tiring issue I have at the moment.