LexAdvice: In a weird spot following escitalopram reinstatement. Help?

[Altostrata]

Please do not panic if you have a rocky patch for a few days. Setbacks are part of the stabilizing process. It can be very frustrating.

[LexAdvice]

Hi everyone,

 

I wanted to thank you for your words of support. I've stuck with the 5 mg dose and things seem to be evening out as I've been sleeping better. I also added an extra midday dose of fish oil and started to take it with Vitamin E, so maybe that is helping.

 

I still feel very tired all the time in spite of sleeping a lot. I remember that this happened to me last year when I was started on Lexapro so I am hoping it will even out soon. I've only been on the reinstated dose for 20 days. I don't think it's the seroquel as I only start to feel this way after I take the Lexapro in the morning.

 

This is thinking very far ahead, but a question about tapering using dry cuts - I don't think I will be able to ask my doc for liquid Lexapro as planned in August to begin my taper because he thinks, after my panicked emails, that we have agreed for me to step up my dose to 10 mg. When I see him next, I believe he'll ok a "step down" to 5 mg and Rx those pills. Can I cut them and weigh them to taper? Can I make that pill into a liquid? How do people proceed with a lex taper without access to the liquid? Thanks in advance for any guidance!

[LexAdvice]

Also - where can I find the list of recommended doctors? Maybe if I had trouble getting the liquid, I could go to a dr. who is pro-tapering.

[LexAdvice]

I am seeing my GP in a few weeks for my annual. It might be possible to tell her that I wish to taper and need the liquid...but I don't know what reason I could give for my pdoc not Rxing it without her asking to call him. Does anyone have any ideas for what I could say?

 

How long does the liquid last? I won't need it until I begin my taper, in August or Sept.

 

Thanks!

[Shep]

LexA, please read through this thread on getting off of Lexapro. 

 

Tips for tapering off Lexapro (escitalopram)

 

This is taken from the above thread:

 

 

Do-it-yourself liquid

People report that they can make their own liquid from Lexapro tablets and water.

It is soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.

See How to make a liquid from tablets or capsules

 

That last link contains a video demonstration. 

 

There's a thread on recommended doctors:

 

http://survivingantidepressants.org/index.php?/topic/988-recommended-doctors-therapists-or-clinics/page-6

 

If you can find a doctor who will support a taper and prescribe the liquid, that is great. However, most of us were pretty much on our own. But as long as you have a steady supply of meds, you can set up a liquid taper using pills with the information found here. 

[LexAdvice]

Hi Shep!

 

Yes, I read that whole thread as well as the info about making liquid but it seemed as if some users had trouble doing so. I'll have to mull over who to ask about Rxing the liquid, but it's good to know that I can at least try to make it at home if that's not an option. Thanks!

[Shep]

I just edited my above post to include a link to "recommended doc". Not sure if you saw it as I was editing at the same time you were posting. 

[LexAdvice]

Thanks, Shep! There's a dr. in my area listed there. I'll copy her info here for future reference.

 

Smith Healy G MD

Psychiatrist

Address: 80 University Pl, New York, NY 10003

Phone:(212) 367-7010

[LexFree]

Hi LexAdvice,

 

I am following your posts and am glad to see you are stabilizing.  I too am tapering generic Lexapro with a liquid.  It is much simpler than a pill.

 

In addition to a psychiatrist, an ARNP, a nurse practitioner, can also prescribe medications and can provide assistance with tapering.  You can Google by Medication Management and the area you live.  Before the first meeting, I had a short telephone conversation to ensure he/she has knowledge on AD tapering.  

 

I hope you will find the assistance you need.

 

Best to you...LexFree 

[LexAdvice]

LexFree,

 

Strength to you in your tapering journey! How are you finding it so far? Looks like you're doing a nice, slow taper.

 

This is invaluable information, especially because NPs are so much more affordable than pdocs. When you found yours, he/she didn't want to know who had been rx'ing you the Lexapro before? like when I go, won't they want to know why my pdoc won't give me the liquid?

 

Thanks for the info and let me know how you're doing!

[LexFree]

Hi LexAdvice,

 

It is going fairly well.  I am still dealing with benzo withdrawal.  Going very slow with hopes the symptoms will be minimal as I get lower.

 

The NP will ask who the previous prescriber was.  You can explain to the NP of why you want to taper and I'm sure he/she will work with you (mine did.)  Especially if they are familiar with ADs.  An NP can also assist with managing other meds you are on.  I hope this helps.

 

Best...LexFree

[LexAdvice]

Hi everyone, thanks again for the support and advice, I thought I'd provide an update. Over the course of a month, I tapered down from Seroquel 25 mg, taking a week of 20 mg, a week of 15 mg, a week of 10, a week of 5 and then went off several days ago. Sunday-Weds nights I slept fine, but last night I had a terrible night of sleep, I finally feel asleep around 3 and then was woken up by a thunderstorm at 5:30 am. Although I'm heartened that as little as 5 mg of Seroquel seems to help me sleep, I really don't want to go back to taking the pills as I'd like to stabilize and then taper my Lexapro. Is it normal for me to expect some rough patches of sleep after dropping the 5 mg Seroquel? If so, how long should it take to even out? Thank you!

[scallywag]

... Over the course of a month, I tapered down from Seroquel 25 mg, taking a week of 20 mg, a week of 15 mg, a week of 10, a week of 5 and then went off several days ago.

 

Sunday-Weds nights I slept fine, but last night I had a terrible night of sleep, I finally feel asleep around 3 and then was woken up by a thunderstorm at 5:30 am. Although I'm heartened that as little as 5 mg of Seroquel seems to help me sleep, I really don't want to go back to taking the pills as I'd like to stabilize and then taper my Lexapro.

 

Is it normal for me to expect some rough patches of sleep after dropping the 5 mg Seroquel? If so, how long should it take to even out? Thank you!

Please do not panic if you have a rocky patch for a few days. Setbacks are part of the stabilizing process. It can be very frustrating.

 

You're in the stabilizing process.  There will be waves of symptoms and windows of time when you feel better.

 

The Windows and Waves pattern of stabilization

[LexAdvice]

Hi guys, I'm hoping to get a moderator's input on my tapering plans. Following up on what I said yesterday, I had another very poor night of sleep sans seroquel. My plan so far had been to get off seroquel entirely, stabilize my sleep, and start my taper of Lexapro according to the guidelines of this site. However, I can feel myself descending into the "crisis zone" of insomnia, and I just don't want to go there. I'm wondering, since I got into this mess in the first place because of insomnia, if it would be more prudent to stay on Seroquel 5 mg at night - after all, it is a very low dose - stabilize, and then taper my Lexapro first, with that cushion of the seroquel there. And then address the seroquel after the Lex taper. Or, does it not really matter either way and I should just try to power through ridding myself of the seroquel? Again, I stopped it I think about 6 nights ago, 4 of them were normal sleep nights and the past two were really bad. Please weigh in. Thanks!

[LexAdvice]

Also wanted to add, I have compounded seroquel that comes in a loose powder inside tiny tiny capsules from the pharmacy. If moderators' advice is to just try to get off it now, would it be worth trying to taper my dose even more? Like unscrewing the capsules and dumping out a tiny amount?

 

I should add that I've gotten off seroquel twice in the past (have used it long-term for insomnia before) and it was never a problem. I never even had the compounded med, I would just break up the 25 mg tablets for like a week and then off. 

 

Last thing! I'm in the process of going through a difficult breakup, my bf and split up only about two weeks ago. Maybe now is not the time to take this project on? Please let me know your thoughts.

[scallywag]

LexAdvice: It's a good question. Drugs can act as either brakes or accelerators. Lexapro is an accelerator, Seroquel is a brake.  Typically we suggest that people taper the "accelerator" drug first. Since it's been a little over a week since you stopped the Seroquel, you could try 2.5 mg to see if it helps. Give it 4 days to reach steady state, then another 4-7 days for your CNS to settle down.

 

Taking multiple drugs? Which to taper first.

[LexAdvice]

Hi Scallywag, thanks for your response. Are you saying that if 2.5 mg seroquel works for me, then I should consider continuing to use it and tapering the Lexapro first? Thanks.

[LexAdvice]

I found this in the "which drug to taper first?" link:

 

And then there are antipsychotics...
To make this a little more confusing, if you are taking an antipsychotic, e.g. Seroquel or Risperdal, you may wish to discontinue that first, because of serious adverse health effects from antipsychotics, such as diabetes.

However, if you're taking an antipsychotic to counter an adverse effect of an antidepressant, such as sleeplessness or agitation, you may want to discontinue the antidepressant first.

Conceivably, one might systematically lower the antidepressant part way, then lower the antipsychotic. If sleep doesn't break up, continue to get off the antipsychotic. If it breaks up, stop lowering the antipsychotic, stabilize, and lower the antidepressant, managing the tapers in a way that preserves sleep.

 

Based on this information above, and considering the fact that I have managed to whittle down the Lex to 5 mg and the Seroquel to 5 mg, I'm considering stabilizing on those same dosages again and then proceeding first with my Lexapro taper. Please weigh in on that plan!

[scallywag]

Yes -- it may make sense to taper Lexapro **after** you stabilize on a reinstated low dose of Seroquel.

 

Please keep track of your symptoms by writing them and your doses down on paper. Here's a great post from Alto about tracking symptoms and doses: Taking notes
 

Just saw your second post about the neuroleptic nature of Seroquel.  A reinstated dose would be 2.5 mg or possibly 5 mg. The start-up dose for Seroquel as an anti-psychotic to treat schizophrenia is 25 mg.  You would be taking 75% - 90% LESS than that dose.

[LexAdvice]

Scallywag, thank you so much. I think that will be my plan. I think it will give me some peace of mind to have the extra insurance of the seroquel while I taper the lex. How long should I give myself to stabilize before tapering lexapro? Before this blip, I'd say I was feeling well and sleeping well for 6-8 weeks. Once I stabilize this time should I give myself a month? 6 weeks? Thanks!

[Shep]

Hi, LexAdvice.

 

I came off a wicked cocktail of 6 drugs, and I dropped my Seroquel last because at the lower doses (under 100 mg), it becomes sedating. So it did help with sleep as I came off the other drugs. I still had severe, chronic insomnia, but I think it would have been worse if I dropped it before coming off the AD and stimulant. 

 

 

 

Last thing! I'm in the process of going through a difficult breakup, my bf and split up only about two weeks ago. Maybe now is not the time to take this project on? Please let me know your thoughts.

 

 

This is a major stressor, and I'm sorry you're dealing with this on top of your taper. As Scally just posted, it does make sense to reinstate the Seroquel and come off the Lexapro first. 

 

Any stress - whether it's too rapid a taper or a break up with your bf - can rattle the CNS and cause symptom flare ups. So do lots of self care now and deal with coming off the meds when you're better able to handle the withdrawal symptoms. 

 

Sending healing vibes your way. 

[LexAdvice]

Hi Shep, I was hoping you'd weigh in because I knew you had taken seroquel in the past! Thanks for stopping by. Your responses have brought a lot of clarity. I don't think that now is the time to be experimenting too much with my dosages, so I'll reinstate Seroquel and stick with it through my lex taper. 

 

How long should I give myself once stabilize to tackle the slow Lexapro taper? I don't think this drug does anything for me and I want off it :/

 

Hope you are feeling well Shep!

[Shep]

I would monitor your sleep and your mood. A breakup can trigger lots of emotions which can lead to neuro emotions, so please be mindful of this. If you haven't already come across this thread, it's a really good one: 

 

Neuro Emotions

 

 

Honor the "real" emotions from the break up and continue the self care. And be prepared for some exaggerated emotions (i.e. neuro emotions) brought on by withdrawal. It may be very hard to separate the two, so do the best you can. Break ups can trigger all sorts of ruminations, regrets, and catastrophic thinking, so you may need to hold for awhile. One trick that really helps me whether it's a "real" emotion or a "neuro" emotion is to change the channel:

 

"Change the channel" -- dealing with cognitive symptoms

 

One reason this works so well is because whether it's real or not, it simply gives your CNS some much needed down time. And in the long run, this will speed up the process. And the more you practice, the better you get. This is the real take away from withdrawal - you come out of it stronger than you came in.  

 

From the info in your signature, it looks like sleep has been "mostly good", so you have a good baseline to shoot for. So it may depend on how well you can deal with the break up. Again, ruminating and feeling depressed are actually "normal" emotions for a breakup, but may be exaggerated due to withdrawal symptoms, so my advice is to keep everything steady and track your symptoms daily and learn to change the channel when needed. 

 

 

 

[LexAdvice]

Hi Shep, thanks so much for your words. I'm glad I mentioned the breakup. Sometimes after a breakup we launch into "get this done now!" mode which I think is why I dropped the seroquel, but actually I think I need to hold onto it: it helps me sleep, and when I feel rested I'm better able to deal with the difficult emotions in the wake of the breakup, as well as do proactive things like exercise and seeing friends - when I'm sleep deprived I wallow at home, which is NOT a good place to be post-breakup. I'll monitor how I feel and re-asses the Lexapro taper in some time. Thanks again!

[Shep]

Yes - the "get this done now" is exactly right! It may be because you feel you need to have something you have control over. So you attach all of your thoughts and your energy to getting this done now, feeling you have control over it, when in fact, you simply need to go into the "let it be" mode.

 

In other words, change the channel! 

 

Take care of yourself, Lex. This will get better. 

[LexAdvice]

Thank you, Shep

[LexAdvice]

I reinstated Seroquel 5 mg last night and slept fine. My current plan is to stay on this while I taper the Lex. I'm intimidated by the future prospect of getting off Seroquel as it seems difficult, but I work with an excellent compounding pharmacy who said they can make the pills as small as 1 mg. So when I attack that later, I can dribble down my 5 mg dose all the way to 1 mg, which seems heartening. Thanks for the advice yesterday!

[scallywag]

Glad to read that you got a good night's sleep.  Thumbs up on your plan.

[LexAdvice]

Hi guys,

 

Since last posting, my sleep mostly stabilized after I reinstated 5 mg Seroquel at night (I'm still on 5 mg Lexapro in the morning). However, the past 3 nights have been bad and I am worried. I don't want to increase my med dosages, in fact I want to start tapering my Lexapro by 10% starting on Sept. 1 and got the OK from a new NP who will Rx the liquid. I am starting to worry and fret and fall into my rumination place. Again, as a reminder, I was Rx'd these drugs for chronic insomnia and they have helped me before, sometimes for long periods of time but I don't want to take them anymore.

 

I'm worried and scared but one thing I haven't tackled in earnest yet is sticking to a regular bed time and wake time. I work from home so I can sleep til whenever I want, I don't think that's working for me though. I also tried going to bed early last night, at 10:30, and after an initial almost-doze off was up for a lot of the night so going to bed early isn't helping me either. I know that the gold standard of sleep hygiene is to stick to a regular bed and wake time so I was thinking about trying midnight to 8 am which is conservative but not punishing. Also, what do people think about stimulus control - getting out of the bed in the middle of the night when I'm awake, then trying again later? I have confidence in these techniques but I know you're supposed to be med-free before trying them so I don't know how that complicates things. I'm afraid to talk to family members or my psych about this because they will want me to up my meds.

 

In short, I'm asking a mod to weigh in on the regular bed/wake time idea. It would be great if AltoStrata could answer given her expertise in this area. Thank you!

[Shep]

Hi, Lex.

 

Have you tried melatonin?

 

Melatonin for Sleep

 

This may help for two reasons. A low dose melatonin may make you sleepy and since it must be taken at a certain time in the evening (the thread explains all of this), it will put you on a good sleep schedule. So two good reasons to look into it. 

 

As far as getting up during the night, I found that sometimes it helped, and sometimes not. There were times when I needed the distraction of getting up and clearing my head. And other times, I needed to rest and let my body rest, even if my mind was in full awake mode.

 

I learned to forget what all I thought I knew about sleep and insomnia because this isn't regular insomnia. I found that I could function at work with 0 - 2 hours of sleep at night for months. I found that if I had a list of movies and tv shows I wanted to watch on NetFlix, I even looked forward to some of my sleepless nights. 

 

And since you work from home, you don't even have to worry about a commute. I take the train or walk, so I don't worry about getting into a car accident, and that's the biggest real danger with insomnia. Everything else is more or less a painful inconvenience. 

 

Another good link for this is:

 

Sleep problems - That Awful Withdrawal Insomnia

 

 

And one more - this is a guided sleep meditation from the viewpoint of being on a train gliding through the countryside. It's best with headphones and it has a bit of a ASMR effect.

 

https://www.youtube.com/watch?v=syqW2c361lA

 

Let us know what you think of the melatonin.

 

Sending healing vibes your way. 

 

 

[LexAdvice]

Hi Shep, thanks as always for this helpful response! The thing is, I don't think this is withdrawal related insomnia since I'm still on consistent doses of my meds. It's probably my usual chronic insomnia that I take the meds for. So I'm still on the meds but in times like these they don't seem to work which is why I was asking about the sleep-wake schedule. I was wondering if that might help reinforce my patterns and help the meds do their job. What do you think? And do you think you could ask altostrata to weigh in since this is her area of expertise? Thank you!!

[Shep]

I've asked the other mods to weigh in on your Seroquel reinstatement.

 

As far as having withdrawal insomnia while you're still on your meds, I was still on 6.25 mg of Seroquel for almost a year after my benzo jump and I still had horrible insomnia the entire time. The point of staying on the Seroquel wasn't just for sleep (because sleep problems started long before that). It was more to keep my nervous system from destabilizing even further. 

 

I would still check out the links I posted, as the "awful withdrawal insomnia" link contains other links that deal with the sleep / wake cycle. 

 

Also, have you had medical tests for your "chronic usual insomnia"? If this was something that you had before meds, it could be related to nutritional deficiencies or a medical condition.  If it's related to anxiety, than the non-drug coping skills like mindfulness and yoga might help. 

[LexAdvice]

Hi Shep, thanks so much on your continued guidance. A little further up in the thread, you'll see that I asked you all to weigh in on staying on seroquel while I taper lex and it seemed like a good idea, which is why I reinstated. It seems to have mostly helped and I plan to taper it after I get off Lexapro.

 

Could I still try melatonin while on these other meds?

 

I'd love to hear others' thoughts on trying to establish a more regular sleep routine. Thanks!!

[Shep]

The below post really needs to be here, so I copied it from where you posted it on my thread and pasted it here. 

 

Don't forget about the cortisol cream, as that may be as big a factor as anything in your recent insomnia. 

 

You may want to give yourself some time from when you last used this cortisol cream before making any other changes. 

 

 

 

SHEP: OMG. I just posted on my own intro thread about some insomnia over the past few days. I ALSO have a heat rash (in my armpits, yuck) which I have NEVER had in my life before, I've been using cortisol cream too, do you think that could be the culprit?! Why would it affect sleep?

 

So glad to hear about a mega partial window for you!     Thanks for your continued support and guidance.

 

[LexAdvice]

Crossing my fingers that it was the cream! I haven't used it since this morning...

[LexAdvice]

Day 1 of my Lexapro taper! From generic liquid. 4.5 mg as of today. Cross your fingers for me