PeppermintMocha: Want a Successful Escitalopram Taper

[PeppermintMocha]

I tried to summarize my drug history in my signature, though 2020 and 2021 are a bit hazy.  Like a lot of people during the pandemic, my world exploded.  Husband lost his job and the business we own together was shutdown.  Because we  supply to big box retailers who remained open, we were working crazy hours trying to adapt without employees.  I was worried about my adult kids who are first responders and doing COVID patient transports.  We sold our house prior to the pandemic because we were about to start building a new house.  We were in this tiny little rental without natural light thinking it would only be a few months.  LOL.  All new building was shut down.  Bank was not happy when our sources of income disappeared.  I got frozen shoulder and was in constant pain at a time when I couldn't even access a medical appointment.  I'm probably forgetting stuff.  It was a really, really hard time, and prior to this I had never experienced depression.  The pressure I was under was enormous.  I stopped being able to eat and sleep.  I had constant panic attacks. Lost a bunch of weight, and then started to think about how I wouldn't be upset if I died in a car accident or died from COVID. The struggle was real!

 

I was honestly thinking I needed to go into the hospital and have massive amounts of tests run I was so sure I was dying of something.  I was finally able to get a doctor appointment and he diagnosed me with depression and put me on mirtazapine to help stimulate my appetite and help me sleep.  It took a bit to get in with a NP who specialized in psych meds and she transitioned me to escitalopram.   I started seeing a therapist and slowly got better.  My husband was rehired by his company, our business opened back up, we were eventually able to build our house, the frozen shoulder resolved, and my kids stayed healthy.  I have no signs of depression and my reactions to stress events (I'm not calling it anxiety) are appropriate to situations. 

 

After I started escitalopram at 5mg, I began having trouble with dizziness.  The NP saw that as a sign that I needed a higher dose and moved me to 10mg.  The dizziness got worse.  I've had so, so many medical tests that are all normal.  I asked to go back to 5mg since the 10mg didn't help with the dizziness.   I was referred to a physical therapist who believes it's PPPD, and the treatment is SSRIs.  So the NP is against a further dose reduction in the escitalopram unitl the dizziness resolves. 

 

I eventually figured out on my own the dizziness was due to low blood glucose.  I first started with finger pricks at home when I felt dizziness, and eventually paid out of pocket for a continuous glucose monitor. A rare side effect of Escitalopram is reactive hypoglycemia. I reduced the escitalopram on my own from 5 - 3.75 - 2.5.   In addition, I discontinued taking Magnesium Threonate, which I was taking to help with sleep.  I'm trying to take my reductions slowly, but I needed to see if the blood glucose data would show an improvement.  I was having dips into the low 50s of my glucose, but overall I was usually under 70 when I was feeling dizzy. I've been at 2.5mg of escitalopram for about 3 weeks.  I experienced nausea and irritation with the reduction.  And I also have a huge improvement in my blood glucose.  I'm having very few periods of hypoglycemia and I'm finally experiencing rises with meals and I'm overall feeling less dizziness.  I'm fairly convinced that the dizziness will go away completely once the escitalopram is discontinued. 

 

I just had an appointment with the NP, who was very resistant to reduce my dosage or agree to use liquid escitalopram.  She believes I'm on 5mg.  I know it's not a good idea to not be fully forthcoming to your medical providers, but I feel like she labels every physical symptom I have as mental illness and she's uninformed about tapering.  She is of the belief that even though I have no symptoms of clinical anxiety or depression, I need the SSRI to remain stable.   That is what she told me to explore in therapy.  To be agreeable and accepting of using an SSRI for the rest of my life.

 

I'm planning to stay at 2.5mg for 2 or 3 months and then think about a slow taper off.  I'm not in a hurry now that the dizziness has improved and I'm feeling much much better. 

Edited December 3, 2024 by Emonda
Name to title

[Emonda]

Welcome @PeppermintMocha

 

1 hour ago, PeppermintMocha said:

I have no signs of depression and my reactions to stress events (I'm not calling it anxiety) are appropriate to situations. 

 

I was always told, "That sounds like a perfectly normal response to a stressfull situation". It doesn't sound like the sort of scenario where you need to take Escltalopram for the rest of your life.

 

1 hour ago, PeppermintMocha said:

I've had so, so many medical tests that are all normal.

 

It's good you've ruled other things out.

 

1 hour ago, PeppermintMocha said:

a physical therapist who believes it's PPPD, and the treatment is SSRIs. 

 

1 hour ago, PeppermintMocha said:

she labels every physical symptom I have as mental illness and she's uninformed about tapering.  She is of the belief that even though I have no symptoms of clinical anxiety or depression, I need the SSRI to remain stable. 

 

Some doctors love labels so that they can give you a pill.

 

1 hour ago, PeppermintMocha said:

I've been at 2.5mg of escitalopram for about 3 weeks

 

If you want to taper, very slow is the way to go.

 

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.

 

1 hour ago, PeppermintMocha said:

I experienced nausea and irritation with the reduction.

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.

 

1 hour ago, PeppermintMocha said:

I just had an appointment with the NP, who was very resistant to reduce my dosage or agree to use liquid escitalopram.  She believes I'm on 5mg.

It's your choice. Some on this site don't involve their doctor with the taper. You just need to keep receiving the prescription for the AD.

 

1 hour ago, PeppermintMocha said:

I'm planning to stay at 2.5mg for 2 or 3 months and then think about a slow taper off.  I'm not in a hurry now that the dizziness has improved and I'm feeling much much better. 

It's good to be stable before you start tapering. A wise lady here likened it to not wanting to start a marathon with a sprained ankle. You don't want to start tapering when you already have WD symptoms. I initially tapered too quickly before finding this site. Once I found this site, I held my dose for 5 or 6 months, then began to slowly taper.

 

You should read this:

 

Here's some general info:

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.

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

Omega-3 fatty acids (fish oil)

Avoid alcohol.

Don't change the manufacturer of your AD.

Once again, welcome to S.A.

Emonda

[PeppermintMocha]

Thank you for the helpful welcome, @Emonda

 

At some point, I'll figure out how to quote a single line.  I've been at 2.5mg for three weeks.  My system seems to have already settled on it and I'm feeling pretty good. I'll hold here for a bit and taper maybe in Feb. 

 

The NP did prescribe me liquid escitalopram, even though she was very against it.  When I cut the 5mg pills in half, it isn't always precise.  Hopefully, starting the liquid now will give my system a few weeks to adjust before I start tapering.  

 

I want to thank everyone who's posted their story.  I've read quite a few intros before joining and they've helped me figure out my best path forward.  

[Emonda]

53 minutes ago, PeppermintMocha said:

At some point, I'll figure out how to quote a single line.

 

Just highlight with your mouse and press "quote selection".

 

53 minutes ago, PeppermintMocha said:

I'll hold here for a bit and taper maybe in Feb. 

 

Good to see you'll take your time. It's not a race.

 

53 minutes ago, PeppermintMocha said:

The NP did prescribe me liquid escitalopram, even though she was very against it.

 

Some people find the transition hard. Please have a read of this link (4th post down by Gridley): Transitioning from pills to liquid

 

55 minutes ago, PeppermintMocha said:

When I cut the 5mg pills in half, it isn't always precise. 

 

Accuracy and consistency are vital. Breaking tablets in half meets neither of these requirements...we all start out doing this.

 

Keep us posted.

 

Emonda

[PeppermintMocha]

On 12/3/2024 at 2:02 PM, Emonda said:

Some people find the transition hard. Please have a read of this link (4th post down by Gridley): Transitioning from pills to liquid

 

Thank you.  My prescriber didn't mention this.  

 

On 12/3/2024 at 2:02 PM, Emonda said:

Accuracy and consistency are vital. Breaking tablets in half meets neither of these requirements...we all start out doing this.

 

I usually just cut the pill in half the best I can and then decide if I want the small half or the large half for the night.  Then take the other half the next night so at least I'm getting a consistent 5mg every two days.  

 

I'm feeling especially grateful for my improved health.  Mornings were the worst with the hypoglycemia and dizziness.  It was so hard to get out of bed, shower, and head to work. There's a lot of people relying on me so taking it easy isn't an option.  I'm now waking up feeling physically well with energy and optimism. I can't believe the difference.   The last thing I want to do is backslide so I will switch to the liquid cautiously.     

[PeppermintMocha]

Was able to see my PCP and showed him the data on the continuous glucose monitor.  He said he'd have to do research into why the Lexapro would cause hypoglycemia resulting in dizziness, but it is clear from the data that it was having an effect.  You can see my numbers improve when I lowered my dose.  His advice is to taper off the Lexapro as fast as I can since I no longer need it and it's causing significant adverse effects.  

 

The switch to the liquid went fine.  I've noticed some mild brain fog symptoms, like recalling names and places and this could also be from perimenopause.  Nothing I'm concerned about.  I'm eating and sleeping normally, which is why I started the Lexapro to begin with. My daughter had surgery and I handled it fine. I was going to wait until February or so to reduce again, but I may make a small cut after Christmas. I've been at 2.5mg for more than 5 weeks.  I think if I was going to have a hard time with the reduction from 3.75-2.5 it would have appeared by now.