1DayATATime: Tapering from 5MG Lexapro?

[1DayATATime]

Hello Surviving Antidepressants forum Moderators and Peers,

 

New user here.

 

I've been having chronic Anxiety and Panic attacks since +/- July of this year, where the symptoms I had prior to starting Clonazepam and Escitalopram (generic Lexapro) in September came back in force after stopping the Clonazepam (despite the fact that I slept anxiety free while using them) after reading how addicting the benzodiazepines are.

 

I am not sure what's going on really, since starting the prescribed meds with or without the Clonazepam and despite the level of Escitalopram I have been waking every morning between 4 and 5am with horrible anxiety which can last throughout the day until early evening when finally I get a window back to my normal self.

 

Given the short time I've been on either of these medications I don't know if I have been experiencing W/D, or, if the Escitalopram is just not working to elevate the anxiety condition.

 

The Escitalopram seems to having a calming effect between 11:30pm and +/-4 or 5am but somewhere in that 1-hour window I wake suddenly with a racing heart, dark thoughts and a number of other disturbing and uncomfortable physical symptoms.

 

The psychiatrist says that I need to increase to 10MG in order for the medication to be at therapeutic dose. I am tormented what direction to take, though my instinct tells me there must be a way to solve the troubling anxiety and panic conditions without the psych meds.

 

I am hoping (fingers crossed) that given my short history taking the Escitalopram that I can completely drop off the medication at this point and figure out some alternate method to quell my morning anxiety dilemma?

 

Sorry for the rambling, thank you in advance for any advise you might be able to share. 

[JanCarol]

Hey 1Day - welcome to SA!

 

You've had a lot of significant changes.

 

You've certainly gone into withdrawal from clonazepam, but it is my belief that it would be dangerous to re-start it.

 

Your 5 mg escitalopram is a good place to be.  Going up and down like you did, can really cause a lot of problems - bouncing your brain like a basketball, when our brains are not made of rubber!   If it were me, I would hold there until well after the holidays.

 

Meanwhile, get yourself educated:

Intro to Antidepressant Withdrawal Syndrome

Withdrawal Dialogues - cartoons to encourage you

Healing from Antidepressants - Patterns of Recovery (by Toxic Antidepressants)

Delayed Onset of Withdrawal Symptoms

Preparing to Taper

 

and, my favourite: 

Non Drug Techniques for Coping with Emotional Symptoms

 

I hope you see the sun today!

[1DayATATime]

Thank you JonCarol for your feedback and the resource references!

 

I am pretty sure the psychiatrist will not support me staying at 5MG, he is already giving me a significantly hard time for not adjusting up to 10MG, referring to it as "the therapeutic dose." 

 

Don't you think that the short time I have been on the medication and the (relatively) low dosage levels I've been on could mean that the withdrawals will be lessened?

[nz11]

Welcome 1daat

Just curious ..what was the reason for the panic attacks in july? illegal drugs? legal drugs?

 

Have you ever taken any so called medicines from the doctor prior to the ones in your drug sig.?

[ChessieCat]

Hi 1DayataTime

 

Welcome to SA from me too.

 

As NZ11 asked, have you taken or are you taking any other drugs.  It is important for us to know your full drug history so we can offer suggestions based on accurate information.  It will be helpful if you would please include details in your Withdrawal History in your Signature for the last 12-18 months of  all drugs, dates, doses and discontinuations & reinstatements.  If you can't remember dates, please write it as "early March" or "mid-August".  Please provide a summary of any drugs prior to that which can just be listed with start and stop years. Please include all prescription, non-prescription drugs and supplements you are currently taking.

 

Here are some more links with helpful information:

 

Before you begin tapering what you need to know

 

Six Mistakes I've Made in Withdrawal   #1. Deferring to Medical Authority

 

What should I expect from my doctor about withdrawal symptoms?

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

 

Keep it Simple, Slow and Stable

 

Tips for tapering off Lexapro (escitalopram)

[bubble]

Hello from me too.

 

I will just briefly echo what others have said. What prompted you to come here and seek advice is clonazepam withdrawal. As unplesant as it is it's actually quite mild because you weren't taking it long. So I would stay away from it and deal with 4 am anxiety which is very typical withdrawal symptom and will pass.

 

By coming here you also took a step in unpaitenting yourself and taking an active role and possibly even control over your wellbeing. The thing is you don't have to do what a doctor says. If you need sonebody to keep prescribing the drug until you manage to safely come off you can take a 10 mg prescription from that doctor and keep taking 5 mg. One of our moderators is well below 1 mg and his doctor thinks he still takes 40 mg.

 

Don't stop taking Lexapro CT. You are now experiencing what happens when CT a drug. It's not pleasant. Another CT might be a lit worse and make you much more dysfunctional.

 

Wait for your brain to recover from clonazepam CT and then taper Lexapro. Goven that you were on it for a relatively short period of time you might be able to come off faster than 10 % per month. But you will have to let your brain be the judge of that.

 

Inform yourself by studying the links provided here. They will enable you to make an informed decision rather than blindly follow instructions from medical professionals. If you look around the board you will soon see so much suffering that it caused.

 

Be prepared to look into non-drug ways of coping whatever caused you to resort to taking drugs in the first place.

 

You can do it.

[nz11]

Just wanted to comment once more

The psychiatrist says that I need to increase to 10MG in order for the medication to be at therapeutic dose. I am tormented what direction to take, though my instinct tells me there must be a way to solve the troubling anxiety and panic conditions without the psych meds.

 

1daat

You are going to have to step up and start researching for yourself to get properly informed regarding the so called 'medicines' the doctor is giving you.

These chemicals are very potent and were you informed of the difficulty in getting off them? Side effects? adictiveness? sexual damage?

 

Did your doctor refer you to a pdoc ? Why?

These people are simply 'dealers'   or a term i have recently come across and like is 'vending machines'.

 

escitalopram is actually a very powerful ssri it is twice as strong as citalopram so you are already taking the equiv of 10mg of citalopram.

 

When the drug companies did drug trials all they had to do was beat placebo so the drug companies used much higher/poisonous doses hey why take the risk of being beaten by a  placebo  right ? Of course when you dumb and numb the cns it will return a change on a subjective rating scale and then that is held up as evidence the treatment 'works' and has beaten placebo. When the studies get the drug on the market the trial results are then taken to mean that the doctors should use the higher dose. Hey why not when it means 75 % more in profits right?

As such therapeutic dose is a profit maximizing nonsense term.

Perhaps it should be more accurately defined as 'the maximum dose for which a drug company can get away with refusing to make available a smaller dose.'

 

These drugs are being pushed at ridiculous high dosages and whats more drug companies refuse to make lower dose formulations available encouraging over-medication.

 

Are you able to step up and take responsibility for what you are swallowing un-patient yourself, do your own research.

Spend time reading on this site.

[1DayATATime]

Thank you all, I appreciate your inputs!

 

Based on the feedback I think I did a stupid thing skipping last nights 5MG dose. That would have been +/-10 hours ago and I am already felling like a train wreck    

 

On the topic of drug history:

 

This is my 1st experience with psych meds (as posted) and I have not used any recreational drugs or alcohol in the past 1+1/2 years.

 

I've been having health problems, heart a few years back, and prostate (BPH) diagnosed this year that are definite factors contributing to my anxiety and panic episodes.

 

I will add additional history that includes the meds that I have taken for those problems.

[1DayATATime]

As update I just now took .25MG after missing last night's dose.

[bubble]

I would go back to 5 mg and stay there until the symptoms from clonazepam CT settle down.

 

Why did you start taking the drugs?

 

Do you have any other strategies in place to deal with that?

[1DayATATime]

I am reacting very poorly to that 2.5MG dose. Can anyone tell me if I might expect president physical and emotional symptoms to subside?

[1DayATATime]

sorry, meant 'Can anyone tell me if I might expect persistent physical and emotional symptoms to subside?'

[ChessieCat]

Re your PM to me:  "could use a live person to talk over what is going on for me. Do you know any such resource I can reach out in real time."

 

recommended-doctors-therapists-or-clinics

 

It is best to ask these sorts of question in your topic, that way other mods and members can weigh in too.

[ChessieCat]

re:  "expect president physical and emotional symptoms to subside"

 

Soon, hopefully .  You've only got a few more weeks of the election campaign.

 

And on a more serious note, a few members are actually finding the campaign causing their symptoms to ramp up.

[ChessieCat]

"I am reacting very poorly to that 2.5MG dose."

 

Q1:  What are your current symptoms?

 

Q2:  Are you keeping daily notes on paper?  It can be hard to remember precise details or make comparisons down the track.

       This is so the mods can try to work out what is causing what:  Keep Notes on Paper

 

Q3:  What changes have you noticed in your symptoms?  What has improved / worsened / stayed the same?

 

As JC said:  "You've had a lot of significant changes."

 

It is very important to take the same dose daily at about the same time:  Keep it Simple, Slow and Stable

 

Healing isn't linear:  Windows and Waves Pattern of Stabilization

[1DayATATime]

I am very sorry, the last thing in the world I would do is cause others (all the good people here) any pain. I will not post any additional updates.

[ChessieCat]

 1Day,

 

We are asking these questions trying to help you.  SA is an excellent site for information and support.  Few doctors understand withdrawal.

 

You are probably experiencing Neuro Emotions

[ChessieCat]

It can take time to point people to the information on the site that is helpful to them.

[ChessieCat]

This site is staffed by volunteers.  We do it because we want to help people and teach them the things that we wish we had known.    Many of the mods are experiencing their own withdrawal, other mods withdrew too quickly or went cold turkey and are experiencing withdrawal symptoms.

[1DayATATime]

Understood! It's not like me and not my intention to be an agitator. I apologize for the 'desperation' in my posts. This has been the WD talking today and I have been overzealous.

 

I am grateful that SA is here and for what you contribute! SA is truly unique and special.

 

I will start doing my homework based on the comments and advice given in your all replies.

[ChessieCat]

It's all good.  We understand.

[bubble]

I would go back to 5 mg and stay there until the symptoms from clonazepam CT settle down.

 

Why did you start taking the drugs?

 

Do you have any other strategies in place to deal with that?

[1DayATATime]

It began with anxiety and panic attacks prior to any medications. Those conditions brought on by several coinciding elevated stressors in my life. No matter what I did I was unable to calm down to a state where I could function properly and that's what lead me to the psych meds.

 

Until today after 'Platinum stars' comment I did not think that I was on WD from the clonazepam since I was having the morning/daytime symptoms while I was taking it and did not notice any different day-by-day symptoms after stopping. Actually I did not think I was on it long enough that stopping it would be any problem and noticed that I felt better after stopping the clonazepam with a relief of the fog that it caused waking from it after a sleep.

 

From the start/coming to SA I thought the problem I was facing was how to safely taper off the escitalopram. I thought maybe the morning/afternoon anxiety and panic where WD's because I had been back and forth between 5MG and 10MG dose on the escitalopram and coming to the knowing once here at SA that I need to be off of it completely as quickly as possible. Hence my poor decision to taper from 5MG to 2.5MG yesterday evening. I (wrongly) thought that SA advice would come back and say that was a safe move as I now definitely know what WD is (!) and correcting for the missed dose with 2.5MG at the 12 hour mark did not prove to alleviate the onset WD symptoms which lasted from morning into the early evening.

 

The way I reacted from the 2.5MG makeup dose in the morning today makes me extra reluctant to restart the 5MG program tonight, not sure I could make it through if the crazy symptoms where to return. Doing so (which I intend) would bring me to the 5MG reinstate level that has been recommended here.

[ChessieCat]

Here are some more links to check out:

 

Brain Remodelling

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Why taper by 10% of my dosage?

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

It takes about 4 days for the drug to get to a steady state in the blood and then a few more days for it to register in the brain.  This is why it is important to stick to the same dose.  Changing doses destabilises the CNS (central nervous system) and the more changes you make the harder it can be to recover.

[Altostrata]

Welcome, 1DayATATime.

 

Yes, your taking Lexapro inconsistently or going cold turkey could cause symptoms such as early morning waking with anxiety.

 

Going on and off psychiatric drugs is wearing on the nervous system. The nervous system needs stability.

 

You have demonstrated that cold turkey is a bad idea for you and that a cut from 5mg to 2.5mg causes withdrawal symptoms.

 

If I were you, I would take 5mg Lexapro at the same time each day, allow your nervous system to stabilize, and then taper more cautiously. Read the links you've been given, particularly Tips for tapering off Lexapro (escitalopram)

 

We don't provide personal counseling here by phone or by personal message. Can you imagine how much work that would be?

[JanCarol]

Hey 1Day - you wrote:

 

 

morning anxiety dilemma

 

Ah!  Cortisol spikes!  Learn more here!  http://survivingantidepressants.org/index.php?/topic/33-waking-with-panic-or-anxiety-managing-cortisol-spikes/

 

 

 

my instinct tells me there must be a way to solve the troubling anxiety and panic conditions without the psych meds.

 

Yes!  It's called (link provided before, but it's so good I will post it again):  Non Drug Techniques for Coping with Emotional Symptoms  There are other non-drug techniques scattered throughout our Self Care Forum.

 

Your psychiatrist does not realize how strong these drugs are.  If you have a scientific mind, you might appreciate this:

The importance of tapering on plasma concentration shows that most of the drug inhabits 90% of receptors at very low dose - this is why it's vitally important to go slowly at low doses, because it's a steep, slippery slope, and a 1% change can affect receptor occupancy at exponential levels.

 

could use a live person to talk over what is going on for me. Do you know any such resource I can reach out in real time

 

 

There is a young lad on the West Coast named Will Hall, who does counseling by Skype.  He is not a doctor, but I believe he is a psychotherapist of some sort.  He helps all kinds of people survive the symptoms of madness and withdrawal.  if he cannot help you, he may be able to recommend someone who can.

 

There's an excellent guy here in my hometown, named Rob Purssey.  He uses coping tools from the ACT (Acceptance and Committment Therapy) playbook, and I've heard wonderful things about his techniques, though - he is a full psychiatrist, and thinks that his techniques are a substitute for a slow taper, and sometimes he tapers people too fast.  

 

when in doubt, always ask for the slowest possible taper - which - after your Clonazepam withdrawal and your 5-10 mg Lexapro bounces - you should probably not consider any tapers until after the new year.

 

There is a place here where people welcome phone contact:  http://survivingantidepressants.org/index.php?/topic/2506-would-you-be-open-to-being-my-phone-friend/  Obviously moderators are unable to do so, it is an inefficient use of our time & scant resources.  Plus - we're not qualified to counsel!  We can only help you help yourself.

 

 

 

Until today after 'Platinum stars' comment I did not think that I was on WD from the clonazepam since I was having the morning/daytime symptoms while I was taking it and did not notice any different day-by-day symptoms after stopping. Actually I did not think I was on it long enough that stopping it would be any problem and noticed that I felt better after stopping the clonazepam with a relief of the fog that it caused waking from it after a sleep.

 

See:  Delayed Onset of Withdrawal Symptoms   Sometimes it takes 3, 6, 9 months, or 1-2 years for the rubber band to bounce back.  When you read the links I gave you about withdrawal, you will learn it's not about the drug in your bloodstream or fatty tissues, it's about the way the drug restructures your chemical cascades, your brain structures.  And once your brain has learned to do this on the drug, it's cruel to ask your brain to adjust every week or so with rapid changes.

 

I agree with Alto - I think your reaction to the 2.5 mg (as an interim dose, since you forgot to take it, or skipped it, or something) is an indicator that your brain couldn't "adjust" to it.  I think you will adjust better to the 5 mg dose, that you've been more used to. 

 

Plan to take that for awhile.  How are you getting 5 mg?  Are you cutting a 10 mg tablet?  Do you have a digital scale?  Lexapro is so strong, that it is important for you to be accurate.

 

I hope you have taken your evening 5 mg, and that you are on the way to feeling better.

[1DayATATime]

Thank you all for your thorough and informed replies!

 

I have been back on the 5MG escitalopram since 10/16, trying to keep the dose as consistent as I can using the less then ideal/inaccurate pill cutter method. I am working on getting a 5MG or liquid solution if the doc will approve a liquid solution.

 

Unfortunately even at the 5MG level I continue to have symptoms which (put generically so as not to trigger) have increased in intensity and frequency. I am sure you will not agree but I am wondering if in my case I am meant to CT the escitalopram all together, or maybe drop to 2.5ML for a week and then CT.

 

Or I don't know ... what I have been experiencing each and every day (and through the nights) is just not sustainable.

[ChessieCat]

Have you been keeping daily notes?  We really need these details so that we can try and work out is happening.

1. What time do you take your drug?
2. When do you get the symptoms?
3. What are the symptoms?
4. What has improved / worsened / stayed the same?

 

Remember, you stopped clonazepam CT on 7 October.  That is only 13 days ago.

 

You've been on 5mg escitalopram for 4 days.

 

When you are suffering the period of time seems so much longer than it is.

[1DayATATime]

Hello ChessieCat,

 

Thank you so much for your feedback!

 

I have not been keeping a daily journal but I try here to elaborate on what I have been experiencing. Going forward I try and keep daily notes.

 

 

1.What time do you take your drug?

I had been taking the 5 MG escitalopram between 9pm and midnight. I have a new target and trying to keep consistent taking between 6 and 7pm

 

 

2.When do you get the symptoms?

Morning anxiety is consistent, I wake somewhere between 4 and 6am with a strange physical sensation that I can only describe as some sort of chemical pumping through my nervous system, not sure how to describe it but it is clear to me that it is directly tied to or causing anxiety that immediately follows. Sometimes I am able wait it out and others it gets the better of me escalating to a panic state and-or is with me in the form of debilitating anxiety throughout the day.

 

The symptoms sometimes come while I am awake but more often thy appear when I am sleeping, some nights I wake in panic like clockwork within an hour of falling asleep. The attacks last for about an hour until I calm down and then the cycle repeats after I have another go at falling asleep.

 

 

3.What are the symptoms?

My symptoms have been all over the place, I have been experiencing all of the following (plus a few that I added) as listed on the Dr Glenmullens Symptom List:

 

Low energy (fatigue, lethargy, malaise), trouble concentrating, trouble staying asleep, insomnia, loss of appetite, anxious, nervous, tense, panic attacks with racing heart and breathless, body ach's, chest pains, trembling, jittery, irritability, agitated (restlessness, hyperactivity), weak legs, dizzy (almost to the point of passing out) confusion, cognitive difficulties, manic-like reactions, tinnitus, (mild) auditory and visual hallucinations, feeling detached and unreal.

 

 

4.What has improved / worsened / stayed the same?

I did another one night skip and reinstate since my last update:

10/19 skipped

10/20 2.5MG at 11:pm

10/21 5 MG reinstate at 7:45pm

10/22 5MG at 9:52pm

 

I had a full nights uninterrupted sleep 10/21 into 10/22. Woke with the morning anxiety syndrome but waited it out and had a full day up to this writing without off the chart symptoms.

[ChessieCat]

It is important to take the same dose at a similar time on a daily basis.  Not doing this increases the time it will take to stabilise.  This will mean a longer time getting off the drug.  Some people end up with their CNS so sensitised that they have difficulty stabilising.  Effects on the CNS (central nervous system) are cumulative, so the more you change doses or skip days the worse it can end up being for you.

 

Here is the SA discussion of waking-with-panic-or-anxiety-managing-cortisol-spikes

[1DayATATime]

You can imagine I am not looking forward to taking this med for one more day never mind for months or longer to titrate. I will work on the fixing the time of day taking.

[1DayATATime]

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Why taper by 10% of my dosage?

 

The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs. We believe this conservative tapering method will cause harm to the fewest number of people.

 

The reason this site exists is because doctors are unaware of the greater safety of gradual dosage reduction, usually advise tapers that are too fast, do not sufficiently recognize withdrawal syndrome, and do not know what to do if it occurs.

 

According to the journal literature on antidepressant withdrawal syndrome, anyone who has been taking a drug for a month or more is at risk.

I am back in symptoms today, felling miserable with chills, abdominal cramps, sensitivity to sound, agitated and restless, dizzy etc.

 

I am just coming up on one month with the escitalopram, is it crazy based on the quote from the journal literature to be thinking I may be able to get off the SRRI on a fast taper or CT and that current symptoms are caused by my pre med anxiety/panic and-or by the benzo CT?

[1DayATATime]

Hello all,

Quick update . . .

I stared tapering Lexapro today from 5MG (in pill form) to 4ML 'Escitalopram Oral Solution'. The prescription plan reads as a taper of 1ML per week for four weeks and then done. Hopefully this is acceptable and will be an event free taper rate given the short duration that I have been on the drug.

 

One other change also made and started today is taking low does of testosterone hormone replacement (as gel). Thinking that my low numbers for testosterone (<200) may well be exacerbating the daily/ritual anxiety+panic symptoms I have been experiencing and complaining about.

[scallywag]

What is the dosage of the escitalopram solution, 1 mg = 1ml?
 
When you switch formulations, such as from a pill to a liquid (even one from the same manufacturer), it's best to keep your dosage the same.  Your body may absorb the liquid faster than the pill so you want to give yourself time to adjust. 3-4 weeks is probably long enough.
 
Then once you have settled down with the change to liquid, reduce your dose by 10% or less once per month. Reducing by 1 mg per week will probably cause problems. Pharma manufacturers dismiss the frequency and severity of symptoms; they say they are rare, despite having done no long-term studies.
Why taper by 10% of my dosage?

Start with 10% reductions once every 4 weeks. Then if you tolerate the first 2-3 reductions well and have no wildly swinging symptoms in the 4th week, the next 2-3 reductions you could hold for 3 weeks instead of 4. If no problems with that and your symptoms are stable in the 3rd week, then you could try 10% reductions every 2 weeks.

 

Many members here have had to reduce by less than 10% once they got under 4 mg of Lexapro (escitalopram), though they were on the medication longer than you were.
 

[1DayATATime]

Hello Scallywag,

 

Thank you for your thoughtful and generous feedback!

 

Confirming yes, (to my understanding) the dosage for the escitalopram solution is 1 mg = 1ml (the label is marked as 'Escitalopram Oxalate 5 MG / 5 ML')

 

There is no question in my mind that what you are recommending is the safest and most effective protocol to follow. I am still in a quandary though with regard what to do. I've been having disabling symptoms every day like clockwork for weeks on end and I am not able to try any number of natural supplement remedies because of possible/probable interactions with the lexapro. Put together with the fact that the physiatrist who writes my scripts will not support a longer taper makes a compelling case to fast track to taper. One the other hand I am quit certain that I do not have the resiliency to cope with additional W/D symptoms on top of those that I have been routinely experiencing.

 

One question I had on the liquid, I bit the inside of my lower lip a few days ago and it has been sore and bothering me today since taking the 1st liquid lexapro last night. Wondering if anybody happens to know if the liquid lexapro would tend to irritate minor wounds like that ... and/or is the idea to hold the solution in your mouth for some time, or swallow it straight away?

[scallywag]

Are you taking notes of the timing of your symptoms and doses? Please take notes on paper. This post gives detail about what kind of log is most helpful in identifying the source of symptoms:

Take notes of doses and symptoms  

 

A couple of topics if you want to have a discussion with the psychiatrist about a longer taper:

How do you talk to your doctor about tapering and withdrawal

What to expect from your doctor about withdrawal symptoms

 

Do you have a family doctor / personal care practitioner? Any doctor can prescribe Lexapro.

 

Call your pharmacy about how to take the oral solution.