DellCore: Vision Issues Related to Trying to Discontinue Escitalopram

[DellCore]

Hello all,

 

Please forgive any formatting or spelling errors, as I'm doing this from my phone. I've been an on - off lurker in this forum for 5 years. As you can see in my signature, I've had quite a history of psychiatric drug treatment for depression, anxiety, and ADHD, although I haven't taken ADHD medication for 3 years now. I have a Master's and a Bachelor's in engineering and I have a pretty good full time engineering job so I've managed to do ok for myself so far. I've been prescribed Effexor in the past and I had a somewhat rough time getting off Effexor but I managed to do it, so I'm no stranger to antidepressant withdrawals. I tapered off Effexor between my undergraduate and graduate studies when I wasn't working or studying. I wouldn't say I had any lingering withdrawal symptoms after I completely discontinued the drug. However, I started Lexapro 5 mg just before I started grad school because I thought nothing can possibly be worse than Effexor (wrong),  then increased to 10 mg for the next 1.5 years. I didn't have any side effects I would consider too bad or intolerable during this time. I wanted to come off the drug during grad school so under the direction of my psychiatrist, I dropped from 10 mg to 7.5 mg, then to 5 mg, then to nothing, all within a month. During this quick taper, I didn't experience brain zaps or extreme anxiety, but I did get Visual Snow Syndrome, which caused me a great deal of anxiety. My symptoms were visual static, afterimages, and palinopsia. My psychiatrist at the time said he had never heard of visual snow, so I saw a neuro-opthalmologist who said my eyes were fine, but he couldn't really do anything for my VS symptoms. My anxiety from the VS affected my graduate studies, and for that semester and the following summer, I basically did nothing. I went back to 10 mg of Lexapro just before the fall semester because I was afraid I wouldn't be able to finish my thesis. After I resumed 10 mg, my visual snow symptoms eventually diminished by 95% of what they were to the point where I didn't notice them anymore. In fact, I could only see static if I stared at the sky long enough, but this didn't bother me. I found myself reenergized and worked very hard on finishing my thesis. I graduated that semester and got a full time engineering job. For the next 1.5 years, I accomplished a lot and got promoted. In September of 2023, I made the horrible mistake of trying to quit the Lexapro again (under the direction of a new psychiatrist/therapist who I had been seeing for the past couple months at the time, not the same one who prescribed the Lexapro). I followed the same taper plan I did last time I quit, but on day 4 of taking 7.5 mg, I developed VS symptoms again, which seemed worse than last time. I reinstated to 10, but it was too late. For the next couple of months, I was severely anxious and work was very difficult due to my VS symptoms. I also had new side effects like feeling hot and flushed constantly, dizziness, and mild tinnitus, which caused me the greatest anxiety. The psychiatrist I'm seeing now had never heard of visual snow and she asked a few of her colleagues about it and they had never heard of it either.  I'm guessing I'm the first patient she's had in her practice who's had severe side effects from trying to discontinue an SSRI. She believes my VS symptoms are related to anxiety, which I think is partially true. I got my eyes checked by an opthalmologist and my eyes were healthy. As a side note, I am somewhat near-sighted and I wear corrective lenses. I then saw a neurologist NP, who had never come across VSS in her practice. She referred me to a neuro-opthalmologist who I have yet to see and suggested that my VS symptoms were anxiety related and that maybe I should increase my Lexapro dose. However, I felt that the VS symptoms were getting gradually better but the tinnitus was bothering me a lot. Just before I went home for the holidays, my psychiatrist expressed concern about my tinnitus, which she acknowledged as a side effect of Lexapro, and thought I should try to taper off the Lexapro again. She scared me by saying she was concerned that it would get worse or become permanent if I didn't get off the Lexapro or switch to another drug (with all I've been through, I don't think I want to touch psychiatric meds again). So, we put together a taper plan using the 5mg/5mL liquid escitalopram solution where I would start with 10 mg then slowly decrease by .2 mL increments per month. Last Monday, I took 10 mL of the solution, but it made me feel sick. I'm not sure if this was due to anxiety over the tapering process or if I somehow measured the dose wrong. Either way, I felt too scared to continue, so I just switched back to my pills the next day. Big mistake. Now my VS is bad again, with the addition of diplopia whenever I'm reading. I'm very distraught and severely anxious now and I fear I'll have to quit my job and move back in with my parents. Reading the stories here of people who continue to have severe problems from these drugs years after they discontinued them doesn't give me any hope. So, any advice on how I should continue? I see my psychiatrist again on the 16th.

[Jane318]

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

 

Thank you for completing your drug signature.

 

On 12/28/2024 at 9:40 AM, DellCore said:

I started Lexapro 5 mg just before I started grad school because I thought nothing can possibly be worse than Effexor (wrong),  then increased to 10 mg for the next 1.5 years. I didn't have any side effects I would consider too bad or intolerable during this time. I wanted to come off the drug during grad school so under the direction of my psychiatrist, I dropped from 10 mg to 7.5 mg, then to 5 mg, then to nothing, all within a month. During this quick taper, I didn't experience brain zaps or extreme anxiety, but I did get Visual Snow Syndrome, which caused me a great deal of anxiety.

This taper was much faster than SA recommends.  Those that taper too quickly often develop very unpleasant withdrawal symptoms, which can include vision issues: This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience.

 

On 12/28/2024 at 9:40 AM, DellCore said:

I saw a neuro-opthalmologist who said my eyes were fine, but he couldn't really do anything for my VS symptoms

On 12/28/2024 at 9:40 AM, DellCore said:

I got my eyes checked by an opthalmologist and my eyes were healthy.

I am glad you have ruled out other causes.

 

On 12/28/2024 at 9:40 AM, DellCore said:

I found myself reenergized and worked very hard on finishing my thesis. I graduated that semester and got a full time engineering job. For the next 1.5 years, I accomplished a lot and got promoted.

From one (retired) engineer to another - Congratulations on your accomplishments! (I didn't finish my Master's, so I am doubly impressed!)

 

On 12/28/2024 at 9:40 AM, DellCore said:

In September of 2023, I made the horrible mistake of trying to quit the Lexapro again (under the direction of a new psychiatrist/therapist who I had been seeing for the past couple months at the time, not the same one who prescribed the Lexapro). I followed the same taper plan I did last time I quit, but on day 4 of taking 7.5 mg, I developed VS symptoms again, which seemed worse than last time. I reinstated to 10, but it was too late. For the next couple of months, I was severely anxious and work was very difficult due to my VS symptoms. I also had new side effects like feeling hot and flushed constantly, dizziness, and mild tinnitus, which caused me the greatest anxiety.

I am so sorry for your suffering.  It seems most mainstream healthcare providers are clueless about how to safely taper off these powerful drugs.  From your narrative, it appears this is your third AD taper.  It is not unusual for each successive taper to be more difficult than prior ones.  

 

On 12/28/2024 at 9:40 AM, DellCore said:

The psychiatrist I'm seeing now had never heard of visual snow and she asked a few of her colleagues about it and they had never heard of it either. 

SA and similar sites offer the best information on AD withdrawal. 

 

On 12/28/2024 at 9:40 AM, DellCore said:

my psychiatrist expressed concern about my tinnitus, which she acknowledged as a side effect of Lexapro, and thought I should try to taper off the Lexapro again. She scared me by saying she was concerned that it would get worse or become permanent if I didn't get off the Lexapro or switch to another drug (with all I've been through, I don't think I want to touch psychiatric meds again).

Drugs.com lists tinnitus is a possible but uncommon side effect of Lexapro.  It is also a common withdrawal side effect.  It is possible your symptoms are related to your third attempted fast taper in September.  Your system may have become sensitized as a result of multiple drug / dose changes and too-fast tapers.  I can understand from your history why you would not want to switch to another drug.  

 

On 12/28/2024 at 9:40 AM, DellCore said:

So, we put together a taper plan using the 5mg/5mL liquid escitalopram solution where I would start with 10 mg then slowly decrease by .2 mL increments per month. Last Monday, I took 10 mL of the solution, but it made me feel sick. I'm not sure if this was due to anxiety over the tapering process or if I somehow measured the dose wrong. Either way, I felt too scared to continue, so I just switched back to my pills the next day.

 

It is not unusual to experience adverse effects from switching from pills to liquid.  For this reason, SA recommends a gradual transition -Transitioning from pills to liquid.

 

On 12/28/2024 at 9:40 AM, DellCore said:

I'm very distraught and severely anxious now and I fear I'll have to quit my job and move back in with my parents. Reading the stories here of people who continue to have severe problems from these drugs years after they discontinued them doesn't give me any hope. So, any advice on how I should continue? I see my psychiatrist again on the 16th.

SA can advise you on how to safely discontinue Lexapro and encourage you in how to develop non-drug strategies for dealing with your depression and anxiety.  Drugs are not the long term solution and often make things worse.  

 

Here at SA, we recommend the hyperbolic taper method, which you can read about here:  Why taper by 10% of my dosage?  With a hyperbolic taper, the reductions are based on the prior dose and so get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc.  (As an engineer, you get this!)  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.  A slow, controlled taper the is key to success and avoiding long-term / permanent side effects.  The best way to accurately measure doses is using a liquid.  If you decide to do this, I recommend a gradual transition back to the liquid form per the link above.  I recommend you stabilize at your current dose before starting your taper.  

 

Suggested reading:

Before you begin tapering - what you need to know.

 Important topics in the Tapering forum and FAQ  

Tips for tapering off escitalopram (Lexapro)

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

Hypersensitivity and kindling

 

Pattern of Stabilization: As you taper, and even in protracted withdrawal, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:

 The Windows and Waves Pattern of Stabilization

 

 

Tracking your symptoms: It’s important to keep tabs on your symptoms and adjust your taper amount and schedule as needed.  This will help you identify your windows and waves and reveal your progress, which is encouragement we need! 

You can use the following list of typical withdrawal symptoms to track the severity of your symptoms over time:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)

 

Managing Symptoms: 

 

In terms of coping with symptoms, we have many, many threads on this subject here at SA- I will link some of them below.  It is extremely important that you start working on some non-drug coping mechanisms early in your journey, in order to maximize your chances of getting off of these drugs and staying off of them for good!

Symptoms and self-care

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

Symptoms and self-care

Getting Started With Mindfulness

Cognitive Behavior Therapy (CBT) for anxiety, depression, withdrawal symptoms, insomnia

 

There are a few things you can do to help your nervous system heal.   Eat a balanced, whole foods diet, stay well hydrated, engage in gentle exercise, and get adequate rest/sleep.  Avoid all neurologically active substances, like caffeine, alcohol, nicotine and recreational drugs- these are like pouring gasoline on a fire for your symptoms.  Avoid adding any further psychiatric medications to deal with your withdrawal from psych meds- the effects of these meds on a destabilized nervous system is unpredictable, and taking something else could make you worse.

 

We recommend only two supplements here - magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system.

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

If you decide to try a supplement, even those we recommend here, add in one at a time and at a low dose in case you do experience problems.  If you tolerate it well, you can increase the dosage slowly over time.  

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Best wishes and please keep us posted on what you decide.

[DellCore]

Thank you for the reply. I made a mistake in my original post, I attempted to taper again in September of 2024, not 2023.

[Jane318]

19 hours ago, DellCore said:

I made a mistake in my original post, I attempted to taper again in September of 2024, not 2023.

Yes - I was going by your signature, which has the correct dates.