Smo1959: New member

[smo1959]

I have been on various SSRIs over the last 20 years. I've no doubt they helped me through some very difficult times. Recently I have been trying to discontinue Lexapro. I was on 30mg per day for at least 5 years when my insurance company suddenly decided 30 mg was not medically necessary. They refused to fill my prescription until the dosage was lowered to 20 mg. I tried to taper for a couple of weeks and then ran out completely before the next refill. I went "cold turkey" for about 10 days. I wasn't feeling too bad so I decided this was a good time to quit.

About 3 weeks into this process, I was hit was terrible withdrawal symptoms - "brain zaps", diarrhea, debilitating anxiety and general discomfort. On the up side, I haven't felt so clear headed in many years and am thoroughly enjoying feeling my emotions once again. But I've had to add 10 mg back into my daily regimen to prevent the physical symptoms. Now, about 6 weeks into this crazy, unplanned process, I am starting to feel depressed and chronically anxious.

Long story - not finished yet by any means. I joined this forum to find out what other people are doing, have done to be free of mind numbing SSRIs.

Edited July 19, 2016 by scallywag
tags added

[nz11]

Hi smo,

Doesn't take long for a post to fall onto page 2 these days so thought id catch it before it does.

 

Welcome you have come to the right place for help. Sorry you are in this difficult situation. You have triggered ssri wdl. and it can be very debilitating.

 Depression and chronic anxiety are classic wdl symptoms.

You might like to fill out a drug signature.

 

So glad you found sa.

nz11

[mammaP]

Hi Smo, welcome to SA. You took lexapro 30mg for 5 years, then 20mg for 2 weeks. When did you quit,  and when did you reinstate 10mg? (rough dates will help.) It is shocking that an insurance company can decide not to fill your script to save money! 

 

It will help us if you can fill out your signature strip with the information. We ask all our members to do this so it appears at the bottom of every post and we can see at a glance what is happening without having to scroll right back to the top. You can find instructions to do that here... http://survivingantidepressants.org/index.php?/topic/12364-please-put-your-withdrawal-history-in-your-signature/

 

Some more reading for you, it is better to understand what is happening to your brain and nervous system, it is much easier to cope and not as frightening. 

 

http://survivingantidepressants.org/index.php?/topic/603-what-is-withdrawal-syndrome/

 

What is your symptom pattern? Worse in the morning, evening or bad all the time? Have your symptoms changed since reinstating?  It is possible that 10mg is too high a dose for you now, our nervous systems become sensitive to the drug after being off  for a while. Do you take any other drugs, prescribed or over the counter, including supplements? They can interact with each other sometimes and worsen withdrawal. 

 

Many people find fish oil and magnesium helpful, I wouldn't be without either of those but can't tolerate many other supplements. 

 

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

http://survivingantidepressants.org/index.php?/topic/36-omega-3-fatty-acids-fish-oil/

 

When you are stable again you might want to try tapering again, here is the topic for tapering lexapro safely 

 

http://survivingantidepressants.org/index.php?/topic/406-tapering-off-lexapro-escitalopram/

[smo1959]

mammaP, thanks so much for the reading material. I added my history to my signature but may need to tweak it some after I do some reading.

 

I don't have exact dates but this is the basic timeline:

March - insurance declines my 90 day refill of #135 20mg Lexapro. Although my GP could have appealed, we decided that I would try the lower dose to see how it went. I was completely out when I received the refill at lower dose, but I tried a brief taper by taking 30mg every other day alternating with 20 mg. I did this for approx 2 weeks and went to 20 mg daily.

 

The effects at 20 mg were minimal unless I got particularly stressed - I was a bit more anxious than normal and felt irritable at times. No physical symptoms.

 

June 10? - I ran out of Lexapro before my refill was available due to the brief taper from 30. I went approx 10 days cold turkey. At first I experienced a wonderful clearing of my mind. I felt like I was coming out of a fog and I was suddenly able to feel emotions again that I hadn't felt in ages. The physical symptoms were fairly mild at first but began to intensify. I picked up my refill on June 20. For the next couple of weeks, I tried not to take it. I would take 10 mg when I couldn't stand the anxiety and nausea...I also tried taking a Xanax now and then which helped only slightly. I was off for a week around July 4 and faired better since I could relax and rest at home.

 

July 5 through July 8 or 9 was pure hell. I was physically ill with nausea and diarrhea, headache and brain zaps. My anxiety was so intense I could barely function. Finally this past Saturday I started taking 10 mg per day.

 

Right now, I feel better physically but I am not doing too well otherwise. I am having trouble concentrating at work and I have bouts of anxiety and self doubt that are very distracting. People at work are beginning to notice or maybe I am also paranoid.. I manage a transfusion service at a large, busy hospital... I feel overwhelmed and afraid that my work is suffering... Had dinner with my closest friend tonight and it felt very forced and awkward on my part.

 

Symptoms are mild in the morning and get worse as the day progresses. This was especially true before I started back on 10 mg.

 

So, that's probably too much information. I am going to read what you've recommended. I was taking Mg and fish oil at first but recently got off course this week. I think it helped and will try to get back to it. I'm terribly disorganized right now due to the Lexapro...

 

Other Meds include Wellbutrin XR, estradiol, progesterone,armour thyroid, metoprolol, and Mobic. I have not attempted to discuss all of this with my doctor. I suspect his advice will be to resume the Lexapro or another similar med, and I want to be free of it.

[nz11]

Smo great job on doing the drug sig.

You might like to put all the drugs you are taking into the drugs interaction checker and copy and paste into this thread

https://www.drugs.com/drug_interactions.html

[mammaP]

Thanks Smo, and NZ for chipping in.   It takes 4 days to get a steady state in the blood and then your nervous system needs to settle down. It will take time but you will stabilise.  Could you add all the drugs to your signature for us? It is important to get the full picture because drugs and supplements can affect each other. 

 

Do you take lexapro in the morning or at night? 

 

I agree with NZ to put ALL the drugs into the interactions checker at drugs.com and copy the resuts here. 

[smo1959]

Drug List: My Drug List Email | Print | Save | New list

estradiol

magnesium gluconate

metformin

progesterone

Fish Oil (omega-3 polyunsaturated fatty acids)

Lexapro (escitalopram)

Metoprolol Tartrate (metoprolol)

Mobic (meloxicam)

Super B Complex (multivitamin)

Vitamin D3 (cholecalciferol)

Wellbutrin XL (bupropion)

 

Interactions between your selected drugs

Major

bupropion escitalopram

Applies to: Wellbutrin XL (bupropion), Lexapro (escitalopram)

 

Talk to your doctor before using buPROPion together with escitalopram. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of escitalopram, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Switch to professional interaction data

 

Moderate

metoprolol bupropion

Applies to: Metoprolol Tartrate (metoprolol), Wellbutrin XL (bupropion)

 

BuPROPion may increase the blood levels and effects of metoprolol. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience increased side effects or your condition changes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Switch to professional interaction data

 

Moderate

cholecalciferol magnesium gluconate

Applies to: Vitamin D3 (cholecalciferol), magnesium gluconate

 

Ask your doctor before using cholecalciferol together with magnesium gluconate. If you are undergoing chronic kidney dialysis treated with cholecalciferol you should avoid magnesium gluconate. Using these medications together can cause high magnesium levels, particularly in chronic kidney dialysis. This can cause nausea, vomiting, flushing, low blood pressure, a slow heartbeat, drowsiness, coma, and death. High magnesium levels may also play a role in the development of bone disease in dialysis patients. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Switch to professional interaction data

 

Moderate

estradiol metformin

Applies to: estradiol, metformin

 

Estradiol may interfere with blood glucose control and reduce the effectiveness of metFORMIN and other diabetic medications. Monitor your blood sugar levels closely. You may need a dose adjustment of your diabetic medications during and after treatment with estradiol. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Switch to professional interaction data

 

Moderate

progesterone metformin

Applies to: progesterone, metformin

 

Progesterone may interfere with blood glucose control and reduce the effectiveness of metFORMIN and other diabetic medications. Monitor your blood sugar levels closely. You may need a dose adjustment of your diabetic medications during and after treatment with progesterone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

metoprolol meloxicam

Applies to: Metoprolol Tartrate (metoprolol), Mobic (meloxicam)

 

If you use metoprolol for the treatment of high blood pressure, talk to your doctor before using it together with meloxicam. Combining these medications may reduce the effects of metoprolol in lowering your blood pressure, especially if you use meloxicam frequently or regularly (for example, to treat arthritis or chronic pain). You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Switch to professional interaction data

 

Moderate

meloxicam escitalopram

Applies to: Mobic (meloxicam), Lexapro (escitalopram)

 

Using escitalopram together with meloxicam may increase the risk of bleeding. The interaction may be more likely if you are elderly or have kidney or liver disease. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Switch to professional interaction data

 

Minor

metoprolol escitalopram

Applies to: Metoprolol Tartrate (metoprolol), Lexapro (escitalopram)

 

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

 

For clinical details see professional interaction data.

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

[smo1959]

Thanks everyone! I was able to copy and paste the drug interaction list...taking both Lexapro and Wellbutrin together seems to pose the greatest health risk. I would like to discontinue the Wellbutrin but probably should focus on one thing at a time. I take Vitamin D daily and started back with fish oil, magnesium, and a B complex vitamin to help with symptoms. I take the Lexapro in the morning. I have been on the 10 mg dose for about a week now. The physical symptoms have improved somewhat - only an occasional brain zap and I'm not as nauseated and ill. Having lots of nerve irritation...feels like little pin pricks on my skin - I assume it is related to my nervous system starting to calm down. Symptoms are worse in the late afternoon and evening. I am having bad tension headaches. I think I need to decrease my caffeine intake. I seem less able to tolerate stimulation. I know that Wellbutrin is stimulating and wonder if that is causing problems.

[nz11]

Well done on doing the drug checker thing.

 

I know that Wellbutrin is stimulating and wonder if that is causing problems.

You havent advised  the dosage of wellbutrin. But imo i wouldnt be too worried about it at the moment. 

 

I reckon the  concern is the large drop on the lexapro that is a very powerful drug and it may be that  10mg may not be able to relieve the withdrawal esp. after such long drug use. I guess time will tell.  It will take some time to stabilize at that dose. My opinion is if you cant cope it is better to updose than start adding benzos and antipsychotics to the mix.

30mg of lex is the equivalent of  57mg paxil and you have now dropped to 10mg lex (19mg equiv of paxil) thats some drop. Withdrawal symptoms are delayed and 3 weeks is very early in the process.

 

Wishing you strength.

[smo1959]

I take 150mg of Wellbutrin XL daily. When I get ready to discontinue I will have to go to another form since XL can't really be split. I read about converting to a liquid, etc, but I'm just not that frugal. I will ask my doctor for a new prescription.

 

The Lexapro drop was unexpected initially. A PharmD from my insurance company decided 30 mg was not medically necessary. The letter came with no warnings or taper instructions. I was pretty ignorant of withdrawal so I just accepted his ruling as an opportunity to finally stop. Every time I think about it, I get really angry. I tried a short taper but went to 20 mg pretty quickly. I'm sure you've read the story.

 

I'm considering that I may have to go back up if I'm not able to stabilize at 10 mg. I'm better but still far from feeling well. I'm struggling with whether or not I should talk to my doctor. Obviously he can tell me nothing other than to do a slow taper... At 10mg I am back to feeling flat and joyless - I guess it would be better to be flat and joyless at a higher dose with no physical symptoms than where I'm at today. I will do some more reading and keep trudging on.

[scallywag]

Smo, I know it's not ideal because you pay premiums for the insurance and deserve medically appropriate coverage, but would your doctor prescribe an appropriate dose of Paxil  Lexapro for you to fill and cover the cost of the prescription yourself? Not everyone's budget can accommodate this, but sometimes those who can forget that it's an option.

 

Other things to investigate:

• If you'd been using brand name Paxil  Lexapro, using generic paroxetine escitalopram would be much less expensive.
   
• Brand-name Paxil  Lexapro manufacturer,  Forest Laboratories (Actavis) may have patient purchase assistance programs.

 

Edit: Smo has been taking Lexapro not Paxil.

Edited July 18, 2016 by scallywag
refer to correct SSRI

[smo1959]

Silver star, you are correct, I could pay for the additional Lexapro myself and I am lucky enough that I could probably afford it. I am using generic Lexapro but I can never remember the generic name... I found a wonderful service called GoodRx at Goodrx.com in case anyone needs it. They do price comparisons and offer "coupons" for significant reduction in price - may be in US only. I used it for my son who has no health insurance... A bit off topic, sorry.

 

I keep saying this but I may go back up on dosage so that I can start a more planned, slow taper. I hate the WD symptoms but I have this notion that I would be going backward if I go back up. What I'm hoping is that it will get better - so far that isn't the case.

 

Thanks for the support!

[nz11]

The Lexapro drop was unexpected initially. A PharmD from my insurance company decided 30 mg was not medically necessary. The letter came with no warnings or taper instructions. I was pretty ignorant of withdrawal so I just accepted his ruling as an opportunity to finally stop.

 

This has to be the closest thing to criminal. imo.

 

Silver star is actually our wonderful informative moderator called Scallywag.

The name that sits just above the avatar is determined by the number of posts one has made. My aim is to become a Platinum star by Christmas...fingers crossed. And i am now one post closer.

 

nz11

[smo1959]

Scallywag, how embarrassing! I actually knew where the usernames are but had a momentary lapse...

 

Thanks Gold Star...I mean NZ11!! Good luck with making platinum!

[smo1959]

I have been reading about tapering strategies, and the current thinking seems to be that, when taking multiple Meds, one should work on the most activating drug first. Between the Lexapro and the Wellbutrin XL, it sounds like a good plan would have been to get off Wellbutrin first. Since I clearly started this journey with no plan, should I go back and start over,i.e., go back to at least 20mg Lexapro if not 30 and start tapering the Wellbutrin instead?

 

I can't seem to get my head around all of this information. When I first went off Lexapro for my brief cold turkey couple of weeks, I actually experience a surge of energy and almost euphoria initially. Has anyone ever heard of that type of reaction? It wasn't long of course until the physical WD set in...I went from elation and sleeping well to pure hell almost over night. I think that I am hung up on trying to get back to how I felt initially.

 

I just can't seem to think these days. I want my brain back. The truth is I wasn't thinking very well prior to trying to discontinue. I am feeling so...unsettled. Is this part of my WD experience or is this whole business as complex as it feels? I will keep reading. If anyone can think of anything in particular that might be helpful, I would appreciate the suggestions.

 

Thanks everyone for sharing your knowledge and experience.

[scallywag]

I got one of the drugs wrong so you mixing up my name and the board "status" seems fair.

 

If you haven't already reported your symptoms to your doctor, you should definitely do so and possibly make an appointment to see him/her. For future wrangling with your insurer, it's important that your medical file contains this information.

 

When you update your signature, the "4Ds" are the most important for us to assist you: drugs, doses and dates of dose changes, discontinuations

• 2005 Started Lexapro at 10 mg, increased to 30 mg by 2011
• 2014 Wellbutrin XL 150 mg added
• 2016 Lexapro 30 mg
• March 2016 forced Lexapro dose reduction by health insurance from 30 mg to 20 mg.
• June 10 (ish) you jumped "cold-turkey" from 20 mg to 0
• July 9 reinstated 10 mg Lexapro, after experiencing intense discontinuation/withdrawal symptoms.
• Wellbutrin dose continues at 150 mg throughout 2016

 

2 things about returning to 20 mg Lexapro

• It's not starting over.  Your current symptoms and recent experience of worse provided important information -- Your CNS (central nervous system) cannot handle that kind of bouncing around in dose. Painful and difficult lessons to be sure, but valuable.
   
• You last took 20 mg in mid June. You want to find a dose that stabilizes, hopefully eliminates, your w/d symptoms. Going back to that amount has its risks. Your CNS has made adjustments to the absence of Lex over 3-4 weeks and then to a lower dose over the last week. 20 mg could be more than you "need"
   

I'm hesitant about more bouncing around in dose; you've had a lot of that recently. Your current symptoms will diminish over time if you hold steady at 10 mg. Please let us know

 

How tolerable are your symptoms at 10 mg?

 

What do you notice about symptom intensity over the week and within each day?

 

Don't worry about whether to taper Wellbutrin or Lexapro; let's get your CNS stabilized first.

[smo1959]

At the moment, the 10mg dose is tolerable. I am no longer having spontaneous anxiety and brain zaps. I am having quite a lot of strange neurological symptoms like tingling and burning in my arms and legs - since this is new, I am assuming it is WD. I am having a lot of muscle pain - my doctor has suggested I might have fibromyalgia in the past so maybe AD WD has intensified the symptoms or I'm having a flare. I have a pretty high pain tolerance so I can deal with it for the most part. I am extremely fatigued but that's nothing new.

 

At least for today, I plan to stay at 10 mg and hope that things will continue to improve. Mentally, I have good days and bad - today was good.

[nz11]

Well if you are happy on 10 then that is great. 

As they say pick a dose and stick to it.

Withdrawal is delayed and things may (or may not) get worse in the next month or two.

Yep wdl is like that some days are bad and some are horrible and some are manageable.

As Breggin says in wdl the best rule is to expect the unexpected

[PatriciaVP]

Hi Smo,

 

Fellow Lexapro tapered here. When I started my withdrawal journey I was at 30 mg. As I got down lower and lower, I had to pause my taper in order to get off other meds that the Lexapro had actually CAUSED me to need. Reducing the Lexapro by so much made these other meds intolerable.

 

Now I am down to 10 mg of the Lexapro, and totally off the other meds. I feel like a completely different person! All this medication has really been holding me back. It's been a bit of a tough road, but I'm to the point now where I'm getting excited about where it's taking me.

 

Slow and steady. You'll get there, and so will I. Brighter days are just ahead.

 

Peace, love and healing.

[smo1959]

Patricia VP thanks for the encouraging words. Yesterday was not a good day. I have a lot going on at the moment and had a bit of a meltdown last evening at home which is pretty unusual. I went to bed thinking I may need to go back to 20 mg. in truth I think I need to work on eliminating the things that cause me stress... We hear that sort of thing all of the time and I for one have largely ignored the advice.

[PatriciaVP]

Reducing stress is always important in our search for wellbeing whether in withdrawal or not.

 

Time is another. I believe with time we all can heal no matter how much damage has been done.

 

One thing I've learned through all this is that when I'm panicking and don't know what to do the best thing to do is nothing. It can also be the hardest because I want relief so badly. But the pain always subsidies. Things always get better. If I avoid making major decisions while in a panic, I avoid the possibility of complicating the situation.

 

Hope you're feeling better today.

 

Peace, love and healing.

[KarenB]

Yep, work on the stress stuff.  It's a good option in that it doesn't bring with it any risk of nasty side-effects, and will generally improve things throughout your life. 

 

Increasing a dose on the other hand, brings the risk of further destabilisation, more w/d symptoms, and a greater dose to eventually taper from.  You don't really want to be looking to drugs to solve the problems, cause that's going to make it a bit difficult to keep tapering off them. 

 

I suggest to people that they start building a nest.  Each twig or feather you work into your nest is another support or coping tool.  One by itself won't do much, but many woven together can hold you when things get rough.  There's zillions of ideas here:  http://survivingantidepressants.org/index.php?/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/.  This is the sort of stuff that's allowed me to cope with w/d.

[PatriciaVP]

Love the nest building metaphor.

[smo1959]

I seem to be past the physical symptoms and doing okay on the 10mg in that regard. Mentally, emotionally not so good. I am having a lot of anxiety. I do have a stressful job and right now things are unusually bad due to staffing issues and projects, etc., so some of this is situational. By the end of the day I feel like I absolutely cannot go on another day. Last night I went to the gym and walked for a while but then I couldn't sleep. The exercise had me revved up too much. I should exercise in the morning but never seem able to get going early enough before work. We are having temps in the high 90's with heat index in the triple digits so walking outside at lunch is not possible...but I know exercise is a good stress reliever. If I can go to bed early and get at least 7 -8 hours of sleep, I wake up feeling much better and usually have a better day overall...so clearly I need to sleep. I take my Lexapro in the morning...what if I took 5 mg in the morning and 5 mg later in the day? I hate how I feel in the evenings. Tonight I'm obsessing over my son traveling several hours away for an overnight trip. I have this horrible feeling of impending doom like something bad is going to happen to him. i admit I worry about him a lot but this is a bit over the top. I do feel better writing it down. Maybe journaling would be good... I meditate and pray but lately I cannot get focused on anything quiet and restful because my mind just won't settle down.

 

Still, I want to stay the course and eventually be free of Lexapro. I certainly am not ready to go down any further. Going up might help but it would put me back in the flatlands where I don't feel anxiety or much of anything and I do not want to go back there. Tomorrow will be better.

[KarenB]

I'm trying to think of some movements that don't rev up symptoms.  What about gentle yoga poses that stretch your muscles a little?  I find them great for relieving anxiety. 

 

Sipping cold water with magnesium in it throughout the day is also helpful.  A supply of nuts/almonds to snack on when energy is fading.  A short guided meditation that you listen to both just before you get up, and then again before going to sleep.  I like ones where you actually move your hands, or hold smooth stones - good for those of us who find it hard to focus.

 

Journaling - great idea.  Let it all flow out, with no thoughts to structure or spelling or anything else.  Just flow....

[PatriciaVP]

 I should exercise in the morning but never seem able to get going early enough before work.

 

I've never been a morning person, but I was always able to get up and go to work OK until I had been on the Lexapro for a couple of years. I ended up going on a tone of Adderall which is actually just time-released amphetamines to help me get and stay going, but eventually those stopped working too. I ended up having to quit my job because I just couldn't function after awhile.

 

I'm still having trouble getting going in the morning, but lowering the Lexapro has made the Adderall unnecessary. I do take my 10 mg dose of Lexapro at night.