Pokeshaw: tapering off Lexapro

[Pokeshaw]

Hi All -

 

just wanted to check in to report that after a nice long hold of 4 months i am feeling MUCH better!  That root canal was a rough patch for sure.

 

Happy to say the worst is over and I am in a much better place! 

 

Poke

[bubble]

Very happy to hear that and thank you for letting us know

[Happy2Heal]

hi Poke,

was reading thru your thread and see that  you're now down to just 0.24mgs of lexapro, that's great!

 

I'm in the same dosage ballpark so to speak, and doing well, how are you doing?

 

have your WD symptoms been mild or, better yet, non existent?

 

hope all is going well with you!

[Pokeshaw]

 

I got the email and I just did the survey. Thanks for sending that out, Alto!

 

Thought I'd also do a quick check in since it has been a while.

 

I am doing really well. Still micro tapering. down to 0.2 mg compounded Lexapro. Windows are where I 'live' most of the time. Waves come and go but are not too bad (except for those few months last year after a root canal).

 

I make 3-4% reductions every 15-30 days and every few months find that I have to hold for a couple of months. Have really learned to pay attention to my mind/body/spirit in terms of the taper schedule.

Still very important for me to do regular relaxation/meditation otherwise stress takes me to a bad place.

 

At this point I still deal with a mixed bag of both withdrawal and side effect symptoms but they are generally not severe and they pass more quickly. I have many days with low or no symptoms which I am so grateful for - If there is anything good that has come from this 6 yr ordeal it is a deepening of my practice of Gratitude!

 

I hope all my old buddies are doing OK?  It is odd to come back and hardly recognize anyone!

 

Best,

 

Pokeshaw in Brooklyn

[ChessieCat]

Hi Pokeshaw, great to hear from you and pleased that you are doing well.

 

3 hours ago, Pokeshaw said:

It is odd to come back and hardly recognize anyone!

 

Yes, it's an unfortunate fact that this site is very necessary and that people are not getting the advice they need from the medical profession.  However, it is good that they have SA to turn to.  Hopefully the survey will help to make inroads into a change in the medical profession.  We have a couple of psychologists/psychologists in training who members here and it's great that they are gaining the knowledge and will hopefully be able to use their knowledge and also spread the word to their peers.

[Pokeshaw]

19 hours ago, ChessieCat said:

Hi Pokeshaw, great to hear from you and pleased that you are doing well.

 

 

Yes, it's an unfortunate fact that this site is very necessary and that people are not getting the advice they need from the medical profession.  However, it is good that they have SA to turn to.  Hopefully the survey will help to make inroads into a change in the medical profession.  We have a couple of psychologists/psychologists in training who members here and it's great that they are gaining the knowledge and will hopefully be able to use their knowledge and also spread the word to their peers.

Thanks, Chessie!

 

Good to see you!  I was happy to see the survey. A good thing for sure.

[Pokeshaw]

Just checking in.  Still doing micro taper of Lexapro. down to .135 mg. Able to reduce by 5-10% per month aprox.  Strange mix of w/d and side effect symptoms as I get closer to the end. Wanted to know if anyone else out there is at this similar place in Lexapro micro taper? Would love to check in

 

Thanks,

 

Poke

[Happy2Heal]

hi Pokeshaw

I'm currently off lexapro since Oct but I did a microtaper of a reinstatement that lasted from Oct 16 to Oct 17

I think I jumped off at 0.05

 

I don't know if my pattern is typical but I saw improvement with each passing decrease.

 

now that I am totally off, I continue to improve and feel like I am probably 90 to 95% healed

However, that may be an overestimate, since often I am not aware of symptoms while I have them

I only notice that I *had* them, when they are gone.

 

so it's hard to say how much more healing I have to do.

I am going thru some mild waves but they are tiny tiny things compared to early on!

 

and life is good.

I don't know if this helps you at all.......?

 

I hope so!

 

 

[nz11]

Pokeshaw this is your personalized invite to consider making a submission to the Scottish govt.

see my drug sig for details

thanks

nz11

[Pokeshaw]

Hi everyone!  Been a while since I posted here. The site has changed a bit, I hope I have posted correctly!

 

 I have been moving along with my micro taper off Lexapro using a compounding pharmacy. Once I got down to 0.1 mg the pharmacist had to change the way he compounded the med and is now doing an aliquot. So he makes batches of 100 caps of .01mg each and I now take 9 to make .09mg.  

I had been making 5% reductions ever couple of weeks over the few months before this change. Then I went from .1 mg to .09 and things went wavy after a couple of weeks. I have been at .09 for about 2 and a half months. 

Could it be that multiple reductions over a few months and then a 10% reduction has sent me into a wave? May also be compounded by stress - we have to move and have not found a place yet. 

The last time I had to hold for a long stretch was when I had a root canal a couple yrs ago. I was very sick with W/D symptoms and stayed at same dose for almost 4 months before things evened out.

Anyway - just wanted to start checking in again here since I need to be in touch with others who are doing a slow micro taper of Lexapro.  

Thanks,

 

Poke

[Gridley]

Pokeshaw,

 

Welcome back.  It sounds like you're doing great.  Congratulations on getting so low.  Sometimes multiple reductions can back up on you, and you're doing the right thing to hold.  Stress can also be a big factor in causing symptoms; I know it is with me.  

 

I'm doing the Brassmonkey 2 1/2% per week taper of Lexapro.  No compounding pharmacies here in Ecuador, so I'm tapering using the Gemini scale, pretty much patterning my taper after Brassmonkey's.  I'll have to see how well it works when I get down to the microdoses, which will be a while yet.

 

Gridley

 

 

[Pokeshaw]

Checking in again. Been 3 months holding now and still not stable. The vertigo and nausea are the worst of it. Horrible intrusive thoughts/dread/depression is less intense than a month ago but still lurking.

Trying to find others who are doing  years long  micro taper. I need to hear that others have experienced this after being pretty stable.

 

Stress is definitely a challenge now since I am in the middle of packing to move. But I went thru the illness and death of a very close friend a few months ago and, yes it was very difficult and I had to hold dose but only for a couple of months and it was nothing like this.

This really started when I switched to the aliquot method of compounding and made a 10% reduction. Didnt think that would be such a hit since I had been going along making 5% reductions  every 2-3 weeks for many months. It concerns me that I am so sick with W/D symptoms now. As I said above, this happened 2 yrs ago after I had a root canal. Took 3-4 months to even out. That is my only reference for a wave like this. 

I was concerned that the aliquot dosages were not accurate but the pharmacist assures me that the .01mg caps are within the 5% accuracy range as were the .

I have been at this for years - since 2013.  Feeling pretty worn out by these last 3 months of bad W/D symptoms. I thought that was behind me. This med really messed up my nervous system. Feeling discouraged.....but will carry on!

 

Best,

 

Poke

[Pokeshaw]

Hi Brassmonkey,

 

Been reading along here and your essay/posts on how long taper will take. It is helpful for me. I am currently in a bad wave of symptoms so have returned to the site for some support. I have been microtapering off Lexapro for several years after initial CT off 10 mg. I initially stayed off for 8-9 months and then reinstated at 5 mg and did a wonky taper by trying to cut the pills up into bits.

anyway - I started having it compounded and held a long time before i could make even a 1% reduction. Yrs have gone by and i am now at .09 mg. I just posted about this recent wave.

Once I got down to 0.1 mg the pharmacist had to change the way he compounded the med and is now doing an aliquot. So he makes batches of 100 caps of .01mg each and I now take 9 to make .09mg.  

I had been making 5% reductions ever couple of weeks over the few months before this change. Then I went from .1 mg to .09 and things went wavy after a couple of weeks. I have now been at .09 for 3 months. Have had a few good days recently but then back to the wave. 

Could it be that multiple reductions over a few months and then a 10% reduction has sent me into this wave? May also be compounded by stress - we have to move and have not found a place yet. 

The last time I had to hold for a long stretch was when I had a root canal a couple yrs ago. I was very sick with W/D symptoms and stayed at same dose for almost 4 months before things evened out.

So, i thought I would touch base with you since you have so much experience with this!  Any feedback would be much appreciated!

 

Thanks,

 

Pokeshaw in Brooklyn

[LexAnger]

Damn these poisons! Can't believe such a slow taper still brings up bad waves! Simply insane!

you have been doing so well so far for years, I can be just a wave and I'm sure it will pass. 

 

Lexapro is such a powerful drug to a sensitized system. During my last few months tapering off, 0.0004 mg still made a difference.

 

 

[Pokeshaw]

Hi Lex,  Yes, I am not happy about this wave. But I do have alot going on with this upcoming move at the end of the month and so....I have to accept what is.

 

I am curious, how were you getting such low doses of the Lexapro? were you using liquid? Can you explain exactly how you did that?  I have been having it compounded. the pharmacist would make capsules at 5% reductions but once I wanted to go from .1 mg caps to .095, .09 etc he said his scale would not go that low and he would have to make an 'aliquot' which meant he took 1 mg and made 100 caps of .01 mg each. So I started taking 9 caps to equal .09 mg. The accuracy he claims is within 5% accuracy so....

 

Anyway, just curious how you did it.

 

Thanks as usual!

 

Poke

[brassmonkey]

Hi Pokwshaw-- it's nice hearing from you again, it's been a while. Boy, you're really getting down there, sorry to hear that it's causing trouble.  From what you wrote I would say that you've gone too fast the last several months and it's starting to catch up with you'  So a nice long hold is in order.  All the IRL stress isn't helping either.  I think the last drop caused problems more from changing to liquid than from the size of the drop. BTW it's great that your pharmacist will work with you like this. If the symptoms are really, really bad you might consider going back up to .1mg to help stabilize and then resume your taper in a few months. 

 

Hope you find new digs soon and things start to settle down.

 

Brass

[LexAnger]

That sounds better.

Yes, I used liquid.

 

The smallest measure I can get from liquid is 0.04mg. 

 

So the last few month down from 0.04 is by adding 100ml water to the o.o4mg liquid to make the 100ml solution, exact same methodology your pharmacist used. 

 

The smallest measure I can get from the 100ml solution is again 0.04/100 = 0.0004mg.

 

The solution made out of the liquid is very accurate. 

 

If you trust the 0.01mg capsule is accurate, you can use it like what I did to make diluted solution for a smaller dose than 0.01mg. If you dilute by adding 100 ml water, the smallest dose you can get will be 0.0001mg.

 

 

[LexAnger]

Oh, I used 5ml synrige for all my measures

[Pokeshaw]

Thanks, Lex!  Of course I am not ready to make any reductions but will need to consider a method when the time comes. Not sure how water soluble the compounded capsules are since they consist of micro crystalline cellulose which I dont think is water soluble and Methocel  E4M.

 

Poke

[jonnypeters1234567]

Hi Pokeshaw,

 

How did your reinstatement go for you?

[jonnypeters1234567]

Did it take long to become stable and did your nervous system react?

 

 

[Pokeshaw]

22 hours ago, brassmonkey said:

Hi Pokwshaw-- it's nice hearing from you again, it's been a while. Boy, you're really getting down there, sorry to hear that it's causing trouble.  From what you wrote I would say that you've gone too fast the last several months and it's starting to catch up with you'  So a nice long hold is in order.  All the IRL stress isn't helping either.  I think the last drop caused problems more from changing to liquid than from the size of the drop. BTW it's great that your pharmacist will work with you like this. If the symptoms are really, really bad you might consider going back up to .1mg to help stabilize and then resume your taper in a few months. 

 

Hope you find new digs soon and things start to settle down.

 

Brass

Hi Brass,

 

Thanks so much for replying. You have no idea how much I appreciate it! 

 

I think you may be right about going too fast the last few months. I will definitely hold awhile.  The change was not to liquid though.  My doctor did not think switching to liquid would be a good idea.

The pharmacist was previously making me capsules at 5% reductions but when I wanted to go from .1 mg to .095 he said he couldnt do that and offered to make an aliquot by making 100 caps of .01 mg each so that I would take 9 to make .09 mg. The content is the same - Lexapro, microcrystaline cellulose, Methocel E4M.  I have been on .09 mg (9 caps) for 3 months now and it has been very wavy.  Gut  moves too fast and dizziness, nausea and vertigo are bad along with weight loss and mood issues.

 

Questions when you have time -

 

The pharmacist assures me that the aliquot is as accurate as he can get (within 5% range) but I just keep thinking the problem is the aliquot - since this bad wave began in the weeks after starting with the multiple caps of .01 mg each. 

 Re your suggestion of going back up to .1 and either go back to the .1 mg caps that he can make or take 10 caps of .01mg . do you think it is wise to updose after 3 months at .09?  I have never done this before and dont want to rock the boat. 

When the time does come to start tapering again - I wonder how I can do it? If I go back up to .1 mg caps or use 10 of the aliquot .01 mg caps. The ingredients are not really water soluble.

 

Thank you again!

 

Poke

[Pokeshaw]

Hi Brass,

 

Not sure best way to respond - Do I hit Reply to Topic?  Or Quote and reply?  Sorry, confused.

 

Thanks so much for replying. You have no idea how much I appreciate it! 

 

I think you may be right about going too fast the last few months. I will definitely hold awhile.  The change was not to liquid though.  My doctor did not think switching to liquid would be a good idea.

The pharmacist was previously making me capsules at 5% reductions but when I wanted to go from .1 mg to .095 he said he couldnt do that and offered to make an aliquot by making 100 caps of .01 mg each so that I would take 9 to make .09 mg. The content is the same - Lexapro, microcrystaline cellulose, Methocel E4M.  I have been on .09 mg (9 caps) for 3 months now and it has been very wavy.  Gut  moves too fast and dizziness, nausea and vertigo are bad along with weight loss and mood issues.

 

Questions when you have time -

 

The pharmacist assures me that the aliquot is as accurate as he can get (within 5% range) but I just keep thinking the problem is the aliquot - since this bad wave began in the weeks after starting with the multiple caps of .01 mg each. 

 Re your suggestion of going back up to .1 and either go back to the .1 mg caps that he can make or take 10 caps of .01mg . do you think it is wise to updose after 3 months at .09?  I have never done this before and dont want to rock the boat. 

When the time does come to start tapering again - I wonder how I can do it? If I go back up to .1 mg caps or use 10 of the aliquot .01 mg caps. The ingredients are not really water soluble.

 

Thank you again!

 

Poke

[brassmonkey]

Hi Pokeshaw-- "aliquot " I thought it was a typo for liquid, my bad.

 

The best way is just to "Reply to Topic".  Quoting is best for a very specific question, and I find it tricky to use.

 

It's such a small updose that I don't think the timing would be a problem, but I'd only do it if the symptoms are really bad.  It would be a way of determining if the aliquot  is the problem.  Going up to ten caps for a few weeks to see if anything improves.  If it doesn't then try the 1mgai pills for a month and see if there is any change.  If there is then its the aliquot causing the trouble.  You mentioned that the content is the same for both capsules, that would tend to indicate that the taper speed is the problem and not the medication itself.  I think for right now a nice long hold would be best.  Once things are stable using the aliquot  shouldn't be a problem.

 

Brass

[Pokeshaw]

Thanks, Brass!

 

Yeah, aliquot was a new one for me too!  Amazing what a compounding pharmacist can do.

 

I appreciate your suggestions. I think, maybe (fingers crossed) I just might be past the 'really bad' period and in the 'sometimes really bad and sometimes there is hope' period! 

Early part of day seems to be worse since it all starts after and with any bowel activity.  So today was a rough morning with nasty vertigo/nausea until after lunch and symptoms reduced by 60- 70%.  So if you had asked me earlier today I would have said 'Really Bad'!

The last time this happened things started to even out around 3 months of holding. I have just hit 3 months. Have had a couple of nice windows here and there but mainly it has been wavy.

I guess I will play it by ear for the next few days and then decide about updose.  And, I really like your suggestion re approach to updose to help determine if aliquot is the problem.

 

Will let you know how it goes.

 

Thanks again!

Poke

[Rabe]

@Pokeshaw Hi Poke,

I am tapering and just switched compounded Clonazepam capsules from .1mg (taking 2 and 7) to a .2 and a .7 to save money.  I was tapering the Viibryd and was on the upside and then started the new capsules and hit a pit!  Called the pharmacy and they said the ingredients were all the same...called couple days later and they said there can be a variance of 3%.  For me personally that would and has made the difference I think.  I have 3 months of them which is good.  What I am realizing is that there can be a difference in the compounded things, so when I make a change or get a new batch I am going to get it for a longer period of time so I dont have to worry about that variance so often if that makes sense.  

 

In any case I think if can be the compounded change and you will adjust...it is hard and Im sorry you too found out that way.  We are so sensitive!  Take care!!!

[Pokeshaw]

@Rabe

 

Hi Rabe,

 

Thanks for reaching out. It is so good to hear from someone else using a compounding pharmacy for micro taper.  I really appreciate being able to connect with others who understand! 

 

Yes, going from individual caps at 5% reductions like .110, .105, .100 to the aliquot where I have to take 9 caps of .01 mg was definitely a change. I have decided to updose from 9 caps (.09 MG) to 10 caps (.1 mg) to see if things improve. I have been in a bad wave for over 2 months now and between work and having to move in 2 weeks it is all a bit much. I need to do something and will start with this. As Brass said - try the updose with the aliquot for a few weeks to see if I stabilize.  Hoping I do because then I will be able to continue using the aliquot for remainder of taper. Dont want to have to make any other change of delivery method!

 

Will post updates here for sure.

 

Best,

 

Poke

 

 

[Pokeshaw]

@brassmonkey  Hi Brass, So I decided to updose from 9 caps of .01 mg to 10 caps .01 to see if things even out over time.  Started today. 

Quick question - The pharmacist had suggested taking 9 caps one day and 10 the next to achieve an approximation of .095 mg but I know that is not recommended here. Can you verify if I should avoid doing this and stick to 10 caps a day til stable and ready to make a reduction?

Thanks!

 

Poke

[brassmonkey]

Alternating doses, even little tiny ones, isn't a good idea.  It really plays havoc with the blood serum levels.  Because of all the variables, hours to peak concentration, half life, bio availability etc. it never works out that alternative day dosing becomes an average of the different doses.  It's always best to pick a dose ans stick with it.

[Pokeshaw]

Thanks, Brass. As I thought.

I have up dosed to 10 caps of .01 mg  Lexapro taking me back to .1mg and will see how this goes.

 

Poke

[Pokeshaw]

@brassmonkey  

 

Hi Brass, I wanted to ask how long you think it should take for me to notice a difference with the updose from 9 caps of .01 mg to 10 caps? This is day 3 and no difference yet.  I understand it may take some time but just wanted to ask.

 

Thanks,

 

Poke

 

 

[Pokeshaw]

@brassmonkey 

 

Meant to also include this question -

If I would rather simply go back to the .1 mg capsules rather than using the aliquot 10 caps of .01 mg to see if things improve or not -  how soon could I safely do that?

I have been 3 months on the aliquot - 9 caps of .01 mg and just 3 days on updose to 10 caps of .01mg. 

 

Thanks again for your help!

 

Poke

[brassmonkey]

Any change in dose takes four days to a week to become steady state in the blood.  Until that happens your symptoms can be very unpredictable.  Once things are steady state the symptoms can start to sort themselves out which could take several days to a few weeks.

 

I'd let things settle out for a few weeks before trying the different capsule. Any change is considered a dose change and needs to settle fully before the next one is tried.

[Pokeshaw]

Hi Brass,

 

Checking in here now that it has been a little over 6 weeks since I updosed from 9 caps (.01 mg each) of the Lexapro aliquot to 10 caps meaning I went from .09 mg to .1 mg.  As you may recall from my posts, this was due to a very bad wave.

Things have improved considerably and I do have windows of symptom free time, but I am still dealing with some w/d symptoms - nausea, vertigo and now what I call side effect symptoms - neck/jaw clench and inner ear balance issues. The trend seems to be up though and the weight loss due to extreme nausea and inflammation along with the horrible dread have reduced considerably. So, after 6 weeks I am feeling I should stay longer at this dose before any reduction or change. I have in the past had to stay a good 3 months at a dose due to a bad wave.

I am hoping that things continue to even out so that I can comfortably continue using the aliquot compounded capsules for my taper.  

Also, we moved to new apartment and are starting to get settled. It was very intense but I survived!

 

Question when you have time - I am wondering what will be the best way to follow your taper method accurately when the time comes. Seems to me that since the ingredients of the capsules are not water soluble I might have to get a scale and weigh out the reductions.

The contents of the compounded .01 mg caps are: Lexapro, microcrystaline cellulose, Methocel E4M

Also, I havent done a lot of research on scales but wondering if I will be able to get one sensitive enough to handle this? These caps are not very big!

 

Again, thank you ever so much for your guidance and knowledge!

Poke

 

[brassmonkey]

Hi Pokeshaw--  I'm glad to hear that things are settling down after the updose.  Yea, I'd give it some more time to get good and stable before trying any reductions.

 

I think using the scales is probably going to be the best way to go.  They're not expensive. Would you be able to find out the weight of the powder that they put into each capsule?  It would help to determine where we are headed with all of this.

[Pokeshaw]

Hi Brass,

 

Thanks for your response.

Yes, I will wait before making any reductions. Usually what prompts me to make the reduction is that the side effect symptoms become intolerable. They are starting to appear.  Gut slows down, so constipation, neck/jaw clench increases as does pins/needles in arms and hands, sleep is choppy.

Because I originally stopped the 10 Mg of Lexapro too quickly  and stayed off for 8-9 months before reinstating, my system is very sensitive to it. The longer I stay at a dose the worse the side effects get. They were reason I stopped taking it. So it has been a see saw taper for me!

 

Re how to proceed from here

I tried dissolving one of the capsules in water and was able to do so pretty evenly. I am thinking that working with liquid dilution might be simplest way to go.

Also, I am considering switching back to the 0.1 mg compounded caps and working from there. The 0.1 mg caps are exactly same ingredients made by same compounding pharmacy as the 10 caps of .01 mgs that I am taking now.  I think that with a 5% accuracy range  10 caps can vary more than the 1 cap at .1 mg.  So I understand that switching back to the 0.1 mg cap will be an adjustment but I think for the better.

Then when the time comes I can make a 1-1 dilution and reduce from there following your taper method.

 

Does that sound reasonable?  

 

Pokeshaw