leahbean: Drug mishaps, tapering, illness interference

[scallywag]

leah, if you want something to explain why a slower taper might be better, consider taking the medical science research paper on the the relationship between dose of an SSRI and serotonin transmitter occupancy. Your psychNP might find it informative.
 
The paper is linked in the first post. The first SERT occupancy curves are on page 4 of the paper. The research looked at 4 SSRI drugs: Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram) and Paxil (paroxetine). The researchers also studied the effect of Effexor (venlafaxine). You may know that Lexapro (escitalopram) is the bigger meaner brother/sister/cousin of Celexa (citalopram).

Why taper paper: dose-occupancy curves

[leahbean]

Can anyone differentiate between intense fear/anxiety and paranoia?  Or are they one and the same?  Feeling this way again after my most recent drop of Lexapro.  I'm trying my 75 mg of mag glycinate as needed, not sure if it's really helping much.  I feel this intense fear about the safety of my kids, like feeling afraid when people I've known and trusted my whole life, hold my son.  My daughter is off at overnight summer camp this week, and that's not helping.  I still feel the fear when I see other kids too, like oh my gosh, these kids are so vulnerable, I hope they're not being hurt.  I don't know where this is coming from; I thankfully don't have any personal experience with any form of abuse.  It just makes me feel like such a freak, like I'm going to go schizo on top of everything else.  It's like I can't trust myself to continue to show good judgment around my kids; what if I became one of the unfortunate mothers who hurts their kids?  I couldn't live if something happened to my kids.  I almost feel as if I shouldn't be trusted to take care of them, or be alone with them.  This sucks!!

 

The only other thing I could think, is that maybe the Lamictal is too much for me?  Or that adjusting the Lexapro has made the concentration of Lamictal do something deleterious.  I really wish I could C/T the Lamictal sometimes, being that I haven't been on it all that long.  Has anyone had any experience of Lamictal increasing anxiety or making them feel paranoid?  Someone please help!  These last few days have been so discouraging.  

[Martina23]

leahbean, I have it also, these are intrusive thoughts about you or someone other to hurt your children or other people. It is a withdrawal symptom as I have been told. I have it worse when I have menstruation othertimes it is better. Dont worry, you will not hurt anyone.

[scallywag]

leahbean,  have you tried slowly increasing the amount of magnesium you're taking?  Some people find the mag really helpful with feelings on that anxiety-to-paranoia continuum.  You can probably supplement as high as 400 mg/day safely.  Most of us eat in a way that results in low magnesium, unless we eat lots of greens grown in soil that known to be rich in magnesium.
 
Increases in anxiety are a very common withdrawal symptom. Sometimes it can help to tell yourself that it's a neuro-emotion or that it's "just withdrawal."

Neuro-emotions
 
Fear, panic, and anxiety

[leahbean]

Thanks Scally.  I haven't tried upping the mag too much yet, my tablets are 75 mg each.  My trips to the bathroom have been a little more...eventful since taking magnesium, if you catch my drift.  The whole paranoia thing really freaks me out.  Postpartum psychosis is nothing to fool around with and I feel like when this paranoia feeling starts, it's only going to be a matter of time before I start seeing and hearing things.     It's like withdrawal is taking the things I'm most worried about (someone hurting my kids) and wielding it as a weapon of fear against me.  

 

Any ideas about the Lamictal?  

[leahbean]

leahbean, I have it also, these are intrusive thoughts about you or someone other to hurt your children or other people. It is a withdrawal symptom as I have been told. I have it worse when I have menstruation othertimes it is better. Dont worry, you will not hurt anyone.

Thanks martina.  I'm so glad I'm not alone in this, as terrible as the intrusive thoughts are.  I feel your pain!!

[scallywag]

I just want to be clear about your Lamictal question.  Are you asking whether you can hold steady at Lexapro and start tapering Lamictal?

[Swede]

Hi leahbeen! I'm also suffering from intrusive thoughts and I know how extreamly frightening they can be. For me they started to appear back in 2009 when i was at a low dose of klomipramin. Took me 6 years to realize that it was the medicine that was causing my problems. And took my last cipralexpill in march of 2015. After about 6 month they became worse but in month 16 they have subsided some how often they occur but the intensity of them are still strong. I try not to avoid happenings, doing my daily stuff or whatever even though I'm terrfied many times, just to show my self that I'm in charge of my life. I'M IN CHARGE OF MY LIFE!!!! I often repeat that sentence to myself when its hard. Sometimes counting can be helpful, i count from 1 to 100 slowly and visualize each number at the same time and try to stay focused. Doing stuff you enjoy can also be helpful. When I hangout with people, I try to partipate much in conversations and hopefully i'll be distracted for the moment. Concentrated deepbreathing can help and don't underestimate a good walk or a bicycleride. Take care!!!

[leahbean]

I just want to be clear about your Lamictal question.  Are you asking whether you can hold steady at Lexapro and start tapering Lamictal?

Yes, that's exactly it. However, I know I am going to have to hold the Lexapro for a loooooong time following this most recent cut.  I feel really, really unsteady and I have a lot of stressful events coming up in the next month or so that I just can't afford to be even more anxious about.  It feels like my adrenals are shot to hades....the last week or so has been high cortisol mornings.  I know mainstream medicine doesn't believe in adrenal fatigue, but are there some things I can be doing or taking to support my adrenals?  I have reviewed the fear and panic forum...thanks Scally!

 

So... I am really, really anti-medication...however, I can't deny that I felt less suicidal after starting Lamictal.  I think it's kind of counteracting the Lexapro's side effects, acting as a brake if you will, to this increased anxiety I've been feeling. Will I need as much of a "brake" as I get lower on my Lexapro dose?  This may not be a question that anyone can answer, as we are all so individual.

 

Or maybe when the Lexapro settles, maybe I should D/C Buspar next?  When i look at my drug interactions, the biggest one is between buspar and lexapro.  I only take 7.5 mg at night before I go to bed.  Not sure how well or if it's even working; I know it doesn't work for many people.  it could be the thing that's helping me get to sleep at night, who knows!  

 

I do need to also keep in mind the fact that my family will be moving next spring, and I need to be especially careful about tapering around that time.

 

This is all so frustrating.  

[leahbean]

Hi leahbeen! I'm also suffering from intrusive thoughts and I know how extreamly frightening they can be. For me they started to appear back in 2009 when i was at a low dose of klomipramin. Took me 6 years to realize that it was the medicine that was causing my problems. And took my last cipralexpill in march of 2015. After about 6 month they became worse but in month 16 they have subsided some how often they occur but the intensity of them are still strong. I try not to avoid happenings, doing my daily stuff or whatever even though I'm terrfied many times, just to show my self that I'm in charge of my life. I'M IN CHARGE OF MY LIFE!!!! I often repeat that sentence to myself when its hard. Sometimes counting can be helpful, i count from 1 to 100 slowly and visualize each number at the same time and try to stay focused. Doing stuff you enjoy can also be helpful. When I hangout with people, I try to partipate much in conversations and hopefully i'll be distracted for the moment. Concentrated deepbreathing can help and don't underestimate a good walk or a bicycleride. Take care!!!

Thanks Swede!  I am trying to do the same things as you...living my life the best I can, trying to be social (which is a new thing for me...I've always been an introvert), doing small thing I enjoy, forcing myself to get out and go shopping even though I feel nervous about it (never been scared to do things like that before).  I agree; it does help!  It kind of shows you that you CAN do it, and the more you make yourself do things that make you nervous and see that you survive them...the less fear should have a hold on you. I also tell myself that emotionally and mentally, I'll most likely be in a completely different (better!) place in even a few months' time.  Thanks for commenting!  I truly appreciate it!

[scallywag]

Mindfulness, belly breathing are good for preventing the cascade of hormones that end in adrenal and cortical fatigue. Anything that moves you away from stimulation and toward feeling grounded would make a difference.

 

As for your next dose reduction -- Lexapro or Lamictal -- let's wait and see. As you said, you've got some demanding non-routine events in the near future. Keep notes about your symptoms, they'll probably provide some clues as to what will make sense for a next step when the time comes.

[leahbean]

Still waiting for the most recent drop to settle, I think.  My thinking has gotten very unrecognizable. Sometimes, I feel uncomfortable being around people who look like they're functioning normally.  Kind of a, how are they doing that?  Isn't it exhausting?  I wish I could function normally too.  I'm feeling very gloom and doom still, like what's the point to anything?  Loss of interest in anything, and anyone, and that unfortunately includes my wonderful family.  I know how awesome they are in my rational mind, but sometimes, the feelings for them are just not there.  I don't know what my problem is.  I know I need to pursue counseling for some attitudes that I have about being a stay at home mom; I just desperately want to feel something for my kids. I know I can love them; I act lovingly toward them, but the "motherly" maternal feelings are just not there.  Right now I'm just putting myself through the paces so to speak.  I'm fighting so hard against the idea that this is the real me, that I'm going to feel this way for a really long time, maybe always.

 

My question is, is the Lexapro pooping out?  Or is this just "typical" withdrawal?  Sometimes it feels like it's just stopped working.  I'm scared to do anything further with my meds right now, since it's so hard to know what's doing what.  How I wish I'd stayed strong and never started Lamictal or Buspar.  

[scallywag]

leah -- sometimes motherly feelings JUST AREN'T there.  It's a complete trap and myth that women feel lovingly toward their children at all times.  This happens without psych drugs. Please be gentle with yourself. It may be a symptom of withdrawal, or it may be a symptom of being alive.

[Martina23]

Leah, this can be also side effect of drugs

[leahbean]

Feeling really discouraged today, like this will never end.  The temptation to just quit all my drugs is so strong.  I tried zinc 15 mg at bedtime three nights last week, and I reacted horribly.  This was an attempt to do something about my elevated copper.  I may have to do a radical overhaul of my diet instead, and increase my magnesium.

 

I'm feeling very sedated in the afternoons, about 3-5 hours after taking my Lamictal. Sometimes dizzy, even though I'm sitting still.  Very depressed, not interested in anything, but forcing myself to keep busy and put one foot in front of the other.  

[leahbean]

Okay, I'm going to ask this question even though I know it's been asked ad nauseum all over this board:

 

How do you know what's "you" and what's the drugs?  I know there are some things that I'm a little anxious and unsettled about (how I feel towards being a mother and how being an introvert fits into the mix). But I feel these things to the nth degree on these drugs.  I can't tell if I'm depressed as a cause of these drugs, or if this is really how I am.  This last taper has been rough.  It has had the typical pattern, but the depression part seems to be taking a long time to settle down.  I don't know if this is a sign to slow down,  or if this depression is a neuro-emotion and exaggerated because of the withdrawal.  I feel so apathetic, flat, and anhedonic, and the fact that I take pleasure in almost nothing makes me even more depressed. I can't stand the fact that I don't feel connected to my family, especially my 6 month old son.  I realize I can't feel lovey-dovey all the time, but is a little bit too much to ask for?  Right now my brain says yes to that question, and it breaks my heart.  Something deep inside says, this isn't really you, just hang in there.  Another part of me says I'm a fool for even considering coming off these drugs at this time of my life.  

 

Any insights, anyone?  

[scallywag]

leah -- here's something Alto wrote about withdrawal vs. relapse

[leahbean]

Been awhile since I've been on here.  Overall, I've continued to make progress.  

 

I do need some advice.  This morning, out of the blue, I got a call from my family NP's office.  Apparently, my NP "no longer feels comfortable" continuing to prescribe Lamictal and thinks I need to return to my psychiatrist (which is NOT happening).  I just don't understand.  I've met with her twice regarding my situation in the last two months, and she said NOTHING about this then.  She'll continue giving Lexapro and Buspar, though  ???  

 

I have about one month's worth of Lamictal left.  Maybe it was a mistake to mention that I'm trying to wean off.  I thought I remember there being a thread about how to talk to your doctor, but I couldn't find it.  

 

I don't want to doctor shop, but I also don't know about doing a rapid taper off Lamictal.  Please advise!!

[ChessieCat]

Here they are:

 

What should I expect from my doctor about withdrawal symptoms?

How do you talk to a doctor about tapering and withdrawal?

 

If necessary, you could always go to the psychiatrist so that you can get the script, hopefully with repeats, which would give you more time to find a new doctor.  I like what one member said about saying that they want to be on the lowest possible dose, while intending to get off the drug.

 

You might be able to find something here:  recommended-doctors-therapists-or-clinics

 

Just don't leave it until the last minute.  Time gets away from us.  Use the time you have doing what you need to do to get your script so you can continue tapering the way you want/need to taper.

[leahbean]

Well, I wasted around $400 going to an "integrative" psych clinic, which wouldn't do medication management for me unless I signed up for their outrageously priced "lifestyle" programs (i.e., changing diet, etc.).  So I'm back to square one.  I have an appointment with a new family practice doctor on Wednesday, to hopefully get a script for Lamictal.  I don't what I'm going to do if he says he's not comfortable prescribing it either.  I wish I could get through that psych doctors have no idea what they're doing with the drugs either.  Please pray for me. 

[scallywag]

Sorry the integrative clinic wasn't helpful. Let us know how things go for you with the new doctor. Sometimes it helps if you take current or recent prescriptions bottles with you. When a doctor sees that you are currently (were recently) on a medication, s/he may be more comfortable with prescribing.

[leahbean]

So I did get more Lamictal.  However, I had to get it filled at a new pharmacy because our insurance company switched up preferred pharmacies.  The different generic, I took for about a week before I started feeling nauseous (with middle of the night vomiting) and itchy.  This itching turned into a rash, particularly around my joints..  Fearing that it could be "the" rash, I feel I had no choice but to quit it cold turkey.  It most definitely was not my intention to do such a thing and I know how such an act is viewed on this board. I know now I will have to hold my Lexapro and Buspar for several months, given that I'm moving across the country in May and can't handle any more changes.  

 

The withdrawal effects so far have ranged from extreme dizziness, nausea, waking up in a cold sweat, anhedonia, random crying spells, and feeling like I have the flu (or maybe I just have a really bad cold).  The rash has disappeared completely.  

 

Here's the thing: I don't believe in coincidences.  I may catch flak on here for mentioning God, but I don't believe my situation has escaped his notice.  It may be a mistake to take a sign like getting the rash as a message that I was supposed to quit.  However, my faith is that God will remain faithful to me as he has been throughout this entire situation.  I am still infinitely better than where I was right around a year ago; I am still looking forward to celebrating my son's first birthday here in a few short weeks and I love him more with each passing day.  

 

I guess I'm posting just for an updates' sake.  And also because I know my family doesn't completely understand, so I'm taking my frustration to my computer instead.  Thanks for reading.

[scallywag]

I'm sorry you had to make the jump because of the suspicion of "Lamictal rash." I hope that your sudden stop of Lamictal works out okay for you -- that the symptoms ease quickly and completely.

[leahbean]

It's been 7 weeks since I stopped Lamictal.  Somehow I feel the withdrawal from that is over, it's a gut feeling.  However...

 

I am now back where I was before I started taking Lamictal:  feeling like Lexapro is too strong for me, that it's exacerbating my anxiety and depression, waking with adrenaline spikes, etc.  I feel the worst around my period, so there's still something going on hormonally. My ability to handle stress of any kind is shot. When I wake up I feel totally wound up, thoughts racing.  I'm wondering if I've found myself in "poop out".  It feels like I'm experiencing withdrawal while still taking Lexapro.  

 

I think reinstatement for me, at the dose I reinstated, was a huge mistake. I reinstated a year ago; if it was going to work, shouldn't it have settled by now?  Lamictal only masked the fact that the Lexapro was making me worse.  I don't feel that what I'm experiencing now is Lamictal withdrawal; yes, I'm feeling the absence of it, but only in regards to how it was abating the Lexapro side effects, if that makes sense.  At best, Lexapro is just simply not working for me.  

 

I'm stuck.  I feel like logically, I shouldn't be making any changes right now.  Seven weeks of a cold turkey off Lamictal doesn't sound like long enough to stabilize.  I'm also moving in a few months (though this is a very welcome move...can't get out of dodge fast enough!).  However, I don't feel like I can continue with the Lexapro either.  Right now, I cope with the help of reading, deep breathing, prayer, and magnesium.

 

Any thoughts are welcome.  Thanks as always for reading and offering encouragement!

[KarenB]

Hi Leah, glad the w/d from the lamictal has settled.

 

I'm just trying to establish from your signature which month you CT'd Lexapro, and then which month you reinstated at 20mg? 

 

It's true that we'd expect a reinstatement to have settled by now.  However, it is possible that the reductions you made since reinstating have made it difficult for you to stabilise.  The drop from May 16 was a 25% drop.  Are you now at 10mg?    

 

Yours is a complicated history, so I'll get some other mods to look at this too, but I do feel that you may need a long hold before you can continue tapering. 

 

One other question:  how did you feel after each of those reductions?  Better or worse?  We do have the occasional person here who does feel better for reducing, and in that case a different approach is needed. 

[leahbean]

Hi Karen!

 

Thanks for chiming in.  Sorry for the confusion in my signature....I tapered Lexapro with liquid toward the end of my pregnancy, being at 1.25 a few weeks before my son was born.  I cold-turkeyed the night he was born, Feb. 7 2016.  I reinstated to 20 mg in the hospital on March 10.  I immediately felt like it was too activating, but I was so confused as to why that would be.  I thought it was supposed to make things better.  I felt suicidal pretty shortly thereafter, with severe DP/DR, racing thoughts, etc., and something inside said the drug was the problem.  I decreased down to 15 mg about a month later, in April.  I stayed there until Lamictal was added, then I started tapering Lexapro on June 4, down to 13.75 mg.  

 

Yes, I have been at 10 mg now for about 2 months.

 

I have felt better as I have tapered down, but I'm wondering if I've weathered the drops better because I was on Lamictal?  My last few tapers have been Brass Monkey slides, with pretty predictable patterns.  I've considered switching my dose over to an all-liquid format and just keeping it there for awhile to adjust for any difference in the way it's absorbed, but staying at 10 mg.

[Petunia]

Hi Leah,

Lexapro is stronger than other SSRIs.  However, many doctors are unaware of this and dose it as though it were the same strength. The usual starting dose of escitalopram, 10mg, is equivalent to 20mg-30mg or more of, for example, paroxetine (Paxil). If you are taking 20mg of Lexapro (escitalopram), you are taking a hefty dose of an SSRI.

I was started on 10mg but found it was too activating and dropped down to 5mg and stayed there.

 

So my guess is that 20mg was too much for you. Over time with multiple drug trials, stopping and starting different drugs, our nervous system can become sensitive and a previous dose of a mediation can now cause a bad reaction. This why we always suggest starting with a small amount when attempting to reinstate.

 

From looking at your signature I get the impression that what started as a normal emotional reaction to a difficult situation you found yourself in, has been made worse over time by trying to treat it with drugs which genetically, you don't tolerate well.

 

If you are feeling ok at 10mg, I would hold there for a while. If you want to switch to liquid, you could do that, its easier for tapering. Then when you feel ready, continue with the 10% method, or if the Brass Monkey slide works better for you, use that.

[leahbean]

So it’s been awhile since I’ve posted.  I have been doing very well for the most part, up until about a month ago.  I have been doing the brass monkey slide with great success.
 

I started having some cognitive problems, tingling in my extremities and face, and some eye focusing problems after having some kind of virus in late November.  I became obsessed with the idea that I had MS and couldn’t think about anything else.  My sleep started suffering, so I started taking melatonin (didn’t work), Benadryl (sometimes worked for a few hours), tried trazodone a handful of times (quit it after it made me feel like a zombie).  Panic attacks and day-long anxiety the likes of which I hadn’t experienced since being postpartum started in.  MRI thankfully came back negative except for chronic sinus issues.

 

Throughout this process, I kept my lexapro and buspar doses consistent while trying the different sleep meds.  Now, though, I don’t think the lexapro is doing anything. I feel like I’ve been hurtled into a withdrawal wave, like I’m not even on meds anymore.  I don’t remember how long I’ve been holding at 1.9 mg Lexapro, but I am wondering if it’s pooped out on me.  I’m considering updosing and trying to stabilize at 2.5 mg but I worry that it could kindle and have a paradoxical effect.  I have increased my dose the last two evenings, to 2 mg.  My nervous system feels very unstable.  Has anyone been thrown into withdrawal after being sick?  
 

symptoms are: anxiety from waking until around dinner time, anhedonia, depression, agoraphobia, constant hunger but not feeling like making anything to eat, feeling worse mood wise after light exercise, memory loss, cog fog, some dp/dr

 

Any advice is appreciated.  My family needs their wife/mom back.  

[Altostrata]

Hello, @leahbean It may very well be the aftereffects of the virus that you're feeling. Long covid has many of those symptoms.

 

Why do you think Lexapro has pooped out on you? Which of your current symptoms do you think come from Lexapro poopout? How do you feel after increasing to 2mg?

 

What times o'clock do you take each of your drugs, with their dosages?

[leahbean]

25 minutes ago, Altostrata said:

Hello, @leahbean It may very well be the aftereffects of the virus that you're feeling. Long covid has many of those symptoms.

 

Why do you think Lexapro has pooped out on you? Which of your current symptoms do you think come from Lexapro poopout? How do you feel after increasing to 2mg?

 

What times o'clock do you take each of your drugs, with their dosages?

Hi Alto!  I feel like the anxiety especially could mean poop out.  I will admit that I haven’t looked into anxiety as a long covid symptom; I did have a covid test 8 days after first showing symptoms which was negative (false negative maybe?).  This wave just feels like it came out of nowhere.  Also, the memory problems seemed to be starting before the virus hit me. The flat mood/blunting feels different than any other time I’ve recovered from a virus.

 

so far the 2 mg seems to be okay, it has only been two nights though.  Probably won’t know for sure for another night or two.  I take both lexapro 2 mg and buspar 3.75 mg in the evening around 9.

 

 

[Altostrata]

Suggest you stay with your drug schedule and focus on recovering from this bout of whatever it is.

[leahbean]

Up to 2.2 mg of Lexapro to try and stabilize.  Worst day so far.  Not wanting to do anything at all...just non functional.  My family wants me to go back up to 5 mg....they need me stable and I can’t go back to the psych hospital, not after my last experience years ago.
 

Is it really possible that this could be a wave, after doing so well for the last few years with each drop?  I’m six weeks post virus.  I was so stable before that.  I’m just baffled.
 

also, I’m not sure how to change my intro title...could someone please help with that?

[Altostrata]

In the last 6 weeks, have you forgotten any doses or taken them off-schedule? Had antibiotic treatment or alcohol?

 

On 1/11/2023 at 5:44 PM, leahbean said:

tried trazodone a handful of times (quit it after it made me feel like a zombie).  Panic attacks and day-long anxiety the likes of which I hadn’t experienced since being postpartum started in.

 

This suggests you might have had an adverse reaction to one or more of the drugs you tried, perhaps trazodone.

 

Suggest you look into the possibility this is an aftereffect of covid. If it is, I cannot assure you that any amount of Lexapro increase will compensate for post-virus effects or an adverse drug effect. It's very unlikely it pooped out. You may have increased it unnecessarily.

[leahbean]

There was one evening last week where I tried taking the lexapro in the morning instead of at night, because I thought maybe it was making the adrenaline wakeups worse.  No alcohol or antibiotics.  Multivitamins, turmeric and NAC have been part of my regimen for months.  Also magnesium for sleep.

 

13 minutes ago, Altostrata said:

In the last 6 weeks, have you forgotten any doses or taken them off-schedule? Had antibiotic treatment or alcohol?

 

 

This suggests you might have had an adverse reaction to one or more of the drugs you tried, perhaps trazodone.

 

Suggest you look into the possibility this is an aftereffect of covid. If it is, I cannot assure you that any amount of Lexapro increase will compensate for post-virus effects or an adverse drug effect. It's very unlikely it pooped out. You may have increased it unnecessarily.

So it’s your view that this is a wave?  Would you recommend decreasing the dose?

[Altostrata]

Your schedule change caused withdrawal. Were you aware that this could affect your symptom pattern? Up to you if you want to go back to 2mg. 

[leahbean]

I didn’t think the schedule change would upset things to the extent it has.  
 

also, I forgot to mention (brain fog!!) that there were maybe five or so PRN doses of .25 Xanax in the last six weeks.  Once for the MRI, the others for sleep.  
 

I feel all sorts of destabilized.