philjot on Lexapro for Paxil withdrawal

[philjot]

Dear all in survAD land.  I am new here and am currently on Lexapro 17.5mg and was previously on Paxil 20mg for 13 yrs - then I tapered to quickly and it left me in a bad depression around Jan 2013.  Tried reinstitution of Paxil to no avail and then was switched to Lexapro to no avail.  So I am not better and not stable - but alive.  Also on some Ativan 2mg per day for anxiety which seems to come form Lexapro (who knows).  I am wondering how important it is to get "stable" on something before I withdraw very very slowly from the Lexapro?  I mean, I am a pharmacist ( a PharmD) you would think I would know better.  Now they want to put me on Venlafaxine and/or lamictal.  Seems like the meds they want to use never end (or they said - hey try ECT - it is amazingly effective - right)  So anyway what do you colleagues of mine in the AD Hell say makes the most sense.  Just live with the depression and wean from Lexapro very, very slowly.  Wean from benzo first? and then Lexapro?  Any advice is helpful to me.  By the way, we should have a retreat for those who are interested so we can come and be together and get to know each other as we struggle through this hell.

Philjot

[philjot]

Dear all in survAD land.  I am new here and am currently on Lexapro 17.5mg and was previously on Paxil 20mg for 13 yrs - then I tapered to quickly and it left me in a bad depression around Jan 2013.  Tried reinstitution of Paxil to no avail and then was switched to Lexapro to no avail.  So I am not better and not stable - but alive.  Also on some Ativan 2mg per day for anxiety which seems to come form Lexapro (who knows).  I am wondering how important it is to get "stable" on something before I withdraw very very slowly from the Lexapro?  I mean, I am a pharmacist ( a PharmD) you would think I would know better.  Now they want to put me on Venlafaxine and/or lamictal.  Seems like the meds they want to use never end (or they said - hey try ECT - it is amazingly effective - right)  So anyway what do you colleagues of mine in the AD Hell say makes the most sense.  Just live with the depression and wean from Lexapro very, very slowly.  Wean from benzo first? and then Lexapro?  Any advice is helpful to me.  By the way, we should have a retreat for those who are interested so we can come and be together and get to know each other as we struggle through this hell.

Philjot

[Jemima]

Philjot,

 

I moved your post here because it's your first and because it's about your journey through antidepressant withdrawal.  Please continue to post your comments and questions here  in the "Reply to this topic" area of this thread.  This way your Intro will act as a sort of journal both for you and those members who are following your progress and trying to help. 

 

Here's our topic on tapering off of Lexapro:  http://survivingantidepressants.org/index.php?/topic/406-tips-for-tapering-off-lexapro-escitalopram/ . 

 

Without knowing your drug history, it isn't possible to offer any worthwhile advice, so please put it in the signature area of your profile like so:

 

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

It looks to me as if you went on 20 mg. of Lexapro at some point, but tapered off a bit, but that's just a guess.  It's possible that you dropped the dosage too quickly and that's why you're experiencing continued depression, but without knowing for sure I don't want to make any suggestions.  It usually is best to taper off the antidepressant first and then the benzo because the benzo will help offset withdrawal symptoms from the AD but not vice-versa.  I would also hold off on adding any more medications to the mix, at least for now.

 

Welcome to the forum, Philjot.  You'll find lots of solid information and friendly support here.

 

[wantrelief]

Hi Philjot,

 

I am in a similar situation as you are having switched medications only to now be on a full dose of an AD (Celexa) which is not helping and I am not stable (depression, anxiety and to top it off a constant headache).  I have been contemplating the same questions as you - should I start tapering or keep holding hoping for stability?  I am scared to start tapering since I am not stable but have been holding for awhile now and am not experiencing any change so am unsure how long I should continue to hold.  I am also on a benzo - Klonopin - which I know I have to deal with as well.  What a mess!  I also am in the medical field - am a nurse practitioner and can't believe how different my experience has been from what we were taught in school; that ADs are not addictive and just need to be tapered but taper meant like 2 weeks or something like that!

 

Anyway, just wanted to welcome you and let you know that you are not alone.  I hope we can help one another navigate through this not fun process.  I too wish we could all meet in "real life" - wouldn't be nice if there was somewhere we could all go to go through this hell together?  It feels quite lonely as no one else really knows what we are experiencing.

 

Michele

[Rhiannon]

Phil, if you just went through all of this since January of this year (crashing off Paxil, attempted reinstatement, quit Paxil again and started Lexapro, cut the Lexapro, started Ativan at some point) it's not surprising that you're still not stabilized.  

 

Our brains have never before encountered, in evolution, anything like what these drugs do to them, so their attempts to re-establish homeostasis are improvised and inconsistent, since there's no inbuilt healing mechanism (like there is with most physical insults, broken bones for example, which we've had billions of years of evolution to develop ways to heal).

 

Also check out the conversation about Lexi's Ativan in the benzo area. Ativan is a short-acting benzo and can lead to increased episodes of anxiety, shakiness, emotional lability, etc. as the dose wears off.  This is called "interdose withdrawal." The solution is to try to keep plasma levels more consistent and less roller-coaster by taking multiple equal doses at regular time intervals.

 

2 mg may sound like a small dose, but Ativan is highly potent like Xanax, and 2 mg is considered equivalent to about 40 mg of Valium. So it's not something to ignore.

 

Just based on my experience I'd say your best bet is to hold the Lexapro for now, get your Ativan dosing consistent and your plasma levels evened out and steady, and hold with that program for a few more months and see if you find yourself feeling any more stable.  It's also helpful to keep a journal logging your symptoms (say on a scale of 1 to 5 or 1 to 10) so that you can see how the waves and windows unfold and see that there actually IS progress with stabilization over time.

 

I know the very hardest thing to wrap our minds around is that these meds are really this disruptive and powerful and dangerous, and the second hardest thing is just how much time and patience it's going to take to get off of them safely.  

 

I've seen so many people go through these journeys now, though, that if your history is as you describe (and doesn't include, say, a bunch of other med changes in the past few years other than the ones you've mentioned) you have a very good chance of stabilizing within the next six months or so if you get your Ativan plasma levels sorted out. And once stable, you can definitely taper off the Lexapro and stay off these brain-disabling drugs forever, if you want.

 

Meanwhile, I'd recommend checking out the Robert Whitaker book Anatomy of an Epidemic to learn the history of how these drugs were developed and marketed and how things have ended up in the state they're in today. I think you'd like it.

[Rhiannon]

Oh ps, please post your med history in your sig line as Jemima suggested. It helps us a lot.

[philjot]

What about making a change to a longer acting benzodiazepine? Such as clonazepam (Klonopin) or Valium. seems like that would be easier than the ups and downs of ativan?

[Rhiannon]

What about making a change to a longer acting benzodiazepine? Such as clonazepam (Klonopin) or Valium. seems like that would be easier than the ups and downs of ativan?

 

Yes, people do this. You might want to look on a benzo forum for more information on this approach. 

 

From my experience (my own and, more, my observation of others') it breaks down like this:

 

If the transition to the other benzo works, then you don't have to deal with multiple doses per day, which is way more convenient.

 

People can't always transition successfully to a longer-acting benzo, though, so then you end up (like me) on your former benzo plus having to taper off the long-acting one that you introduced.

 

and

 

The transition itself--even when it does work (which it seems to at least half the time)--is a process that takes some time itself.  

 

Heather Ashton used this method in her work with patients; if you Google "Ashton Manual benzos" you'll find her writings on the subject. I don't agree with absolutely everything she says, but I think her crossover schedules (for transitioning to the longer-acting benzo) and her dosage correspondences are pretty good. They seem to work for most folks.

[lexicon]

Hi Phil,

I am so sorry that you are struggling ..

If you decide to work eliminating the Ativan, and are interested in learning how to have your plasma consistant as Rhi advised you, my thread is under :

Members only - benzo tapering discussion.

My thread is " Please help me ..I am confused "

Wishing you wellness and healing Phil ..

Hang in there ..Lexi

[philjot]

I am on Lexapro after having been on Paxil for approx 12 yrs at 20mg per day.  Anyway - The Lexapro 15mg per day is not relieving my depression and I have anxiety (for which I take Ativan several times per day).  The pdoc wants to start me on Lamictal or has suggested I switch to an SNRI (Effexor).  Both of these ideas scare me as I really believe that these meds are poisons to the body.  However, I don't know about trying to taper through a depression.  

 

As many of you know the SSRIs and probably the SNRIs have an issue with "pooping out".  I believe that what I actually have at this time is tardive dysphoria.  Does anyone have a recommendation or suggestion - has anyone been in this place.  

 

If I were "stable" on Lexapro then I could understand the slow taper process - but what does one do if there is "no stability" with regard to depression?

 

It also seems like a crazy idea to try to get "stabilized" on an SNRI such as Effexor only to then (if I stabilize) have to try to wean off Effexor (which I understand can be much worse than SSRIs)

 

Thank you so much for your input/suggestions

[Jemima]

Philjot,

 

I moved your most recent post here to your Intro topic.  Only one Intro to a customer, please.  This is the place to post comments and questions about your personal journey through withdrawal.  You might want to bookmark your Intro thread or add a link to it in your signature along with the drug history.

[Jemima]

Philjot,

 

I'm still not clear on what dose of Lexapro you're taking.  Your drug history says 20 mg., one post above says 17.5 mg., and your last post says 15 mg.  I'm not sure when you started taking it, either.

 

Assuming that you went on Lexapro at the very beginning of May and have already made two large dosage increases followed by two dosage reductions, it's no wonder that you're experiencing anxiety and akathisia.  As you probably know, 20 mg. of Lexapro is a very high dose, equivalent to roughly 40 mg. of Paxil and that may be contributing to your symptoms.  However, if you've been on it since the beginning of May, it would be wise to stop changing the dose until you become stable.  That can take a month or more.

 

As for changing to a different benzo, my opinion is that making more changes is going to make things worse, and that includes adding Lamictal or switching to Effexor.  Lamictal has helped some people on this forum, but I still would hold off on that for the time being.

 

There is nothing I know of that will relieve your misery immediately.  Getting off of antidepressants for good means putting up with some discomfort and being very, very patient.

 

[philjot]

Jemima, Thank you for your response, Yes I am currently taking 15mg of Lexapro. 20mg was too much and caused the restlessness. So I am planning to hold at 15mg for 4 weeks. I am depressed and have anxiety but it is mostly difficult in the morning to mid afternoon. I take the Lexapro in the early am (~ 4am). I have gone to taking 10mg Lexapro in the am and 5mg in the late afternoon. Do you think that a month of this is a reasonable time to begin tapering (super

slowly, like 10% every 4 to 6 weeks)?

[Jemima]

What's important is to listen to your body rather than set up a rigid time schedule.  If you don't feel good and stable and mostly symptom-free at the end of a month, stay put.  If you do feel good enough to proceed, then do so, but be willing to back up if that causes too much discomfort.  You've already made lots of changes in a short time, so a month may not be enough to stabilize.

 

There is no shame whatever in taking a long time getting off these drugs.  As you probably know, they make changes to the central nervous system and those changes remain in place after the drug is out of one's body.  It's those changes in the CNS that cause withdrawal symptoms if the drug is withdrawn too abruptly, and that's why we recommend taking as much time as you need to remain reasonably comfortable and functional while tapering off. 

 

I'm not sure what the point of taking Lexapro in two doses might be.  When I was on it, I took my pill in the morning and that was adequate for 24 hours, and probably somewhat longer.  Lexapro is highly stimulating and I would think that taking a dose in late afternoon might be at least a partial cause of your sleep problems. 

 

You might also want to divide your Ativan into four doses and take 2.5 mg. four times a day.  Ativan has a fairly short half-life so you may also be experiencing inter-dose withdrawal from it.

 

One problem many of us have suffered is high cortisol levels in the morning and this may be partly responsible for your morning anxiety and depression.  I found that keeping my bedroom as dark as possible and wearing a sleep mask helped me to sleep much more soundly, and I wore sunglasses even inside the house on very bright days.  Once I was able to sleep, other symptoms started to improve.

 

I hope this helps.

[Azgirl]

hi Philjot, I just wanted to comment ..you mentioned you are a pharmacist.  I am a nurse, so I feel the same, I should have a better understanding of what's going on .  But Dr. Breggin has a term, I may need to look it up but I think it's called medication spellbinding.. 

(hope it's ok to post this link? http://www.breggin.com/index.php?option=com_content&task=view&id=187

 

anyways welcome, prayers for your recovery

[philjot]

Thank you so much for your thoughts - yes I have seen that by Dr Breggin.  Prayers to you - for your recovery.

[Jemima]

hi Philjot, I just wanted to comment ..you mentioned you are a pharmacist.  I am a nurse, so I feel the same, I should have a better understanding of what's going on .  But Dr. Breggin has a term, I may need to look it up but I think it's called medication spellbinding.. 

(hope it's ok to post this link? http://www.breggin.com/index.php?option=com_content&task=view&id=187

 

anyways welcome, prayers for your recovery

 

A major part of the problem is that most of what mainstream medicine "knows" about antidepressants and other psychiatric drugs comes from the pharmaceutical companies and their detail men, who have every reason to deceive and outright lie.  (And they do.)  People think they're safe because of the FDA, not realizing that the drug companies do their own research, which is frequently distorted to make a drug look much more useful and less harmful than it is.  The research is passed on to the FDA and pretty much taken at face value.

 

Personally, I was shocked when I found out that doctors do not get any training in evaluating research or in the pharmaceuticals themselves.  And with today's philosophy of making medicine as profitable as possible, never mind the human consequences, the most expedient way to treat patients is by writing prescriptions rather than searching for the cause of disease and correcting whatever can be corrected.

 

My personal philosophy of health care has devolved over the years to: "The more you avoid doctors, the healthier you will be."

[philjot]

Here is my predicament - I am not getting relief from Lexapro - so I am not stable on an SSRI; I am currently on Lexapro 17.5mg per day which I take in the morning (20mg seemed to produce too much agitation).  I have anxiety in the morning about 6 am and begin swallowing and feeling anxious which has given me a hoarse voice, I am tired but have trouble sleeping.  

 

As I had indicated, I am not keen on switching to another SSRI or to an SNRI.  But, as I understand it, it is recommended to get stabilized before you try to titrate off - which I can completely understand. But how does one get stable if you have already pooped out on an SSRI (Paxil) and are not feeling relief from a second SSRI (Lexapro).

 

I can't imagine going through a slow taper (which for me would be 3 yrs to 4 yrs) and remain feeling like I do right now.  It seems that once you develop tachyphylaxis to an SSRI - trying another SSRI is not very useful (I realize that in some cases - people do have success doing this - switching from one SSRI to another.

 

It seems that what we call "withdrawal symptoms" may in some cases be tardive dysphoria induced by the SSRI.

 

I did reach out to the author of the paper, Tardive dysphoria: The role of long term antidepressant use in inducing chronic depression.  His comments were as follows:

 

The best thing is to stop serotoninergic drugs -- both drugs that work as serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors --

 

and use drugs that work through dopamine (like Mirapex),

 

or norepinephrine (like Seroquel),

 

or both (like Wellbutrin),

 

or histamine (like Provigil/Nuvigil).  You can also get your serotonin transporter genotyped.  I think having the short form increases your risk of developing tardive dysphoria.

[Jemima]

I'm not at all clear on what dosage you're taking now. Two days ago you said you were on 15 mg, taken in two doses of 10 mg. and 5 mg.  Today's post says you are on 17.5 mg. taken all at once.

 

I know it's hard to think straight at times during withdrawal, but please try to tell us what you are currently taking and when you made the last change in dosage.  Without knowing this it is nearly impossible to give advice that's anywhere close to useful.

[philjot]

two days ago I was on 15mg taken as 10 mg in am then 5 mg at 1 pm;  - I am now taking 17.5mg all at once in am.

[Altostrata]

Welcome, philjot.

 

It sounds to me like you are finding Lexapro too activating altogether, and are taking Ativan partly to relieve side effects of Lexapro.

 

If I were you, I would gradually reduce the Lexapro. (Ativan presents its own problems, as Rhi pointed out.)

 

Interesting that you corresponded with El-Mallakh. However, I would be wary of his recommendation of other psychiatric drugs. Once the autonomic nervous system is destabilized, you must treat it very gently to help it heal.

 

See http://survivingantidepressants.org/index.php?/topic/392-one-theory-of-antidepressant-withdrawal-syndrome/

[ladybugqt]

Dear all in survAD land.  I am new here and am currently on Lexapro 17.5mg and was previously on Paxil 20mg for 13 yrs - then I tapered to quickly and it left me in a bad depression around Jan 2013.  Tried reinstitution of Paxil to no avail and then was switched to Lexapro to no avail.  So I am not better and not stable - but alive.  Also on some Ativan 2mg per day for anxiety which seems to come form Lexapro (who knows).  I am wondering how important it is to get "stable" on something before I withdraw very very slowly from the Lexapro?  I mean, I am a pharmacist ( a PharmD) you would think I would know better.  Now they want to put me on Venlafaxine and/or lamictal.  Seems like the meds they want to use never end (or they said - hey try ECT - it is amazingly effective - right)  So anyway what do you colleagues of mine in the AD Hell say makes the most sense.  Just live with the depression and wean from Lexapro very, very slowly.  Wean from benzo first? and then Lexapro?  Any advice is helpful to me.  By the way, we should have a retreat for those who are interested so we can come and be together and get to know each other as we struggle through this hell.

Philjot

Philjot,

I don't pretend to be an expert but I have been in LEXAPRO HELL for over a yr... I too tried to rush the process. I couldnt move w/o help, still don't have much of a voice, cant even transfer from my wheelchair in the bthrm w/o hubbys help, etc. IT IS VERY IMPORTANT TO LET UR NERVOUS SYSTEM STABALIZE BETWEEN DROPS - Please, dont be stubborn like me - I am just starting to get back basic functions. W/o my husband, my mom, & my family in this group I wouldnt have made it this far! If u ever need 2 talk - i'm here!