derprant: Coming off 5+ years on and off Lexapro

[derprant]

Hi all. Don't normally do this sort of thing but I've been helped a fair bit by reading through this site, so I thought maybe my input could help others.

 

I've always had a bit of anxiety and neurotic behaviour, but I was originally placed on 10mg Lexapro at ~25 years old due to a cancer scare that knocked my anxiety up a notch. Stayed on it for a few years with pretty good success. No negative symptoms - no ED, no sexual dysfunction, I needed LESS sleep, ended up putting on no weight at all. Pretty perfect. In my stupidity, I decided I didn't need it anymore after a year or two (and my mum was pretty against me using them). Came off them by snapping the 10mg in half to 5mg for a couple of months, and then just cold turkeyed the rest of the way. No real withdrawal besides those horrible brain zaps. 

 

A few years later during my masters, I was having a bit of trouble so doctor suggested I went back on them. Fine. 10mg again, exact same situation - no negative affects (after the first couple of weeks while it built up in my system). Still felt a bit average a few months later, so I took my doctor's advice and went up to 20mg and everything was fine. I really did feel pretty good and normal on it, it never stopped working and nothing bad happened.

 

Fast forward to this year. I turned 30 and decided that I would try to come off the ol' Lexapro. Split my 20mg to half doses of 10mg in about June, then by ~21st of July just ditched them entirely. Cue the standard brain zaps and a horrendous bout of flu-like symptoms (that I perhaps wrongfully attributed to the flu travelling through my office). They both disappeared by mid September and silly me thought 'right, I'm all good'.

 

Randomly, on the 4th of November, I had a horrendous panic attack thinking about death, just from reading the news. Now I've had panic attacks before, but that was during the cancer scare and I was reading about my chances (what a dumb idea). Anyway, that went away and I went out on a night of heavy drinking after work. Saturday, I experienced the general malaise following heavy drinking, but Sunday I began to suffer inordinate anxiety, the likes of which I've never really experienced. It wasn't until then that I started reading about SSRI withdrawal symptoms appearing sometimes months afterwards. Looking back I can see that my symptoms started about 3.5 months after I abruptly stopped from 10mg doses. In addition to that, my GP had always told me that 10mg was a pretty small dose, so I never considered the possibly of needing to taper any further.

 

6/11 I started experiencing massive DP/DR, and gave myself panic attacks reading about the damn Fermi paradox at night (girlfriend: why do you care what an old Italian mathematician says?).  Decided the smart move was to keep a journal so I could see any progression.

 

7-11/11 Was terrible. Felt like dying, and was so close to going back on the lexapro but, somehow, I restrained myself. I can barely remember any of these days, as the brain fog was compounded by intense existential anxiety. At some point I started taking St. John's Wort every night.

 

12/11 suffered a complete breakdown, sobbing and crying in my girlfriend's arms for no real reason. Needed a break so I (perhaps stupidly) took 1/2 a 5mg valium. I know this is advised against but I don't regret it, I really needed it. Calmed me down a lot. Still no appetite and sleep wouldn't come.

 

13/11 Dead and apathetic all day. Forced myself to exercise, which definitely improved my mood from 2/10 to 3 or 4/10. Still not appetite, even after pretty intense exercise. Felt pretty good after the exercise, but had another minor breakdown at night, but not anxious related, just down. Have a holiday planned for next year that I was previously SO EXCITED for, but now...just don't really care? Horrible feeling. At about 8pm I took 3x fish oil pills (1000mg) and one B2 vitamin and BLAM, a massive improvement all of a sudden to 6/10. I was actually happy. Still not excited for the future, but happy in a way? Continued all night. Took the St John's Wort and a Valerian tablet at night and slept really well.

 

14/11 woke up exhausted, but mood was ok. I have avoided caffeine since Sunday, mood was sitting at about 5/10. Apathy and brain fog still readily apparent.Mid morning, my irritability exploded, apathy also became so much worse. Here my diary gets a bit dark so I won't include any of it. Come 4pm, I decided to have a plain black tea and a window of good opened until 6.30pm, at which point it dropped to about 4 or 5/10. Went home and just planted myself in front of the tv. At some point, I noticed that I didn't feel so crap anything at about 7.30pm. I actually went and cooked dinner. This continued until 10.30, when I realised that I might have over-pronounced how I felt - still improved but not as pronounced. Definite general apathy and lack of excitement for the future, but no horrific anxiety/dread like I've had before. Baselined at 5/10 before bed, took 1xfish oil, 1xSJW and 1xValerian before bed.

 

15/11 Good sleep but truly exhausted. 1xfish oil and 1xB2 before work. Anxiety seems lower, brain fog and depression at the forefront. Have noticed that despite all these withdrawal effects, I still have entire sexual function and only slightly lower desire (that I would attribute to the depression and anxious feelings). Mid morning I had a minor sobbing breakdown in the toilet, but went back to neutral after that. Around midday I felt an ever-so-slightly-there tinge of excitement about the holiday next year...maybe? I'm not sure yet, possibly wishful thinking but that's what I need. Forced myself to exercise at lunch time, not as much of an endorphin rush as Monday, but better. Still mostly apathetic though. Pretty hard to care. 

 

And that brings me to right now, as I write this. Happy to accept any insight on offer, or answer any questions anyone has, or even continue updating the thread if it helps anyone. Just want to add that, whilst I might be imagining it (and it seems likely given the short time period), I THINK I am feeling better than I did when I first cracked on the 4/11. In summary, symptoms experienced so far: anxiety/dread, depression, brain fog, apathy, no physical symptoms besides sleeping a lot, no appetite, no sexual dysfunction.

 

Thanks everyone for being so open and honest on this site. I'm sure there are a ton of people who don't end up posting on here that have been helped by it. 

Edited November 16, 2017 by baroquep

[derprant]

I keep hearing a lot about the 'foggy head' symptom, but I'm entirely unable to put it into words properly. Basically: 

I have some pressure behind my eyes and temples

Very easy to lose visual focus (not mental focus, purely visual focus)

I have a very weak ability to recall even short term memories

Bit of stunted emotions (like no excitement for future prospects/ability to picture them)

 

Is this a similar experience that others have felt? 

[AliG]

Hi Derprant.  I'm sorry for what you have been going through but glad you found us and shared your story. As you already know, you tapered too fast. SA ( Surviving Antidepressants) recommends tapering by 10% of your current dose with a hold of at least 4 weeks before your next decrease. the 10% taper method is a harm reduction approach to going off psychiatric drugs.  Why taper by 10% of my dosage?

 

Can I ask you to fill out your signature so that we have access to a brief version of your drug history whenever you post.

Please put your withdrawal history in your signature

 

After 3.5 months, reinstatement is an option. According to medical knowledge, reinstatement is the only way to alleviate withdrawal symptoms. Reinstatement is best done immediately upon appearance of withdrawal symptoms. The more time that passes, the less likely it is to work. The length of this window of opportunity varies according to the individual. Sometimes people can reinstate successfully months after quitting. Others cannot. Often a partial dose will relieve withdrawal symptoms.

 

About reinstating and stabilizing to reduce withdrawal symptoms  Let us know if this is something you are interested in and we can suggest a starting dose.

 

I'll post some links which may be relevant for you. Read through them and come back here to your thread with any questions or comments.

 

What is withdrawal syndrome?

The Windows and Waves Pattern of Stabilization

Brain Remodelling

 

Please feel free to write whenever you want; you will find a lot of friendly help and support here. This is your thread to journal progress and ask questions.

Welcome to SA,

Ali

Edited November 17, 2017 by AliG
spacing

[derprant]

Just a quick update, last couple of days have been really tough. Bit of a blur. Decided to reinstate this morning at 5mg and see where it takes me. Symptoms are so hard to explain...it's like despair and depression and bubbling anxiety, with an anhedonia as well in the background. Last night I slept 3 hours, the night before that I slept 10+. 

 

I've never had any adverse reaction to going ON  lexapro, so hopefully in a few days I'll have some semblance of relief and I can stabilise over the a couple of months and then start a really slow taper. Fingers crossed, not sure what else to do if this doesn't work - the general answer seems to be to just throw more medication at the issue.

 

It's hard because I've been wired to just assume that how I'm feeling now is just the normal me, but I don't remember that being the case...

 

I'm sure I'm getting ahead of myself, but how long should I wait before I consider updosing higher than 5mg, given my uh...less than educated original taper?

[baroquep]

Hi derprant, I'm worried that 5mg might be a little too high a dose to reinstate at ... you might want to reduce the dose tomorrow to 1mg.  It's always best to start low and titrate up until you find some relief from the withdrawal symptoms.  As you've been off of Lexapro since July, your central nervous system has likely made some adjustments and you may find that 5mg will cause increased anxiety and agitation.  Lexapro is a pretty strong antidepressant and you might be able to find relief from as little at 1mg.  Because you have only had one dose at 5mg, I would highly recommend that you reduce your dose to 1mg.  

 

Please review the link on reinstatement below so that you have a good understanding of the procedure and process and what it means to stabilize after reinstatement.  I'll attach the link and draw your attention to the paragraph that I've highlighted below.

About reinstating and stabilizing to reduce withdrawal symptoms  

What to Expect in Reinstatement (James Heaney article)
 

How long should you give reinstatement?

• It takes at least 4 days for your body to fully register the addition of a neuroactive drug. Unless you have an immediate bad reaction, observe your symptom pattern for about a week to see if the reinstatement is helping. If you have an immediate bad reaction, reduce or stop taking the drug.
• After reinstatement, the amount of time needed to alleviate withdrawal symptoms (stabilizing) varies according to the individual. Relief can be felt immediately, after some weeks, or after some months.
• Once you feel withdrawal symptoms are reduced after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Think in terms of months, not days.
• Be patient after you reinstate. Reinstatement may not immediately eliminate all withdrawal symptoms. You may still experience waves of symptoms, which usually lessen as time goes on. Do not attempt to taper again until you feel symptom-free, or at least until your withdrawal symptoms are mild and tolerable.
• The dose needed for effective reinstatement varies according to the individual.

[derprant]

I chose 5mg for a few reasons:

 

Anecdotal evidence on here suggested that the drop from 5mg downwards seems to be the hardest thing ever, whilst 20mg-5mg were mostly non issues.

5mg is the lowest therapeutic dose suggested by GPs and I guess I had that underlying 'what if that's just me' fear

Using the 10% per month taper method, I should ideally be sitting at around 10mg anyway, so I figured 5mg was even lower (June - November = 50% reduction).

 

What do you think? Still suggest 1mg dose? I'm curious as to what the initial 5mg dose might do to me if I immediately bump down to 1mg again...

 

 

[baroquep]

Hi there, I was looking at your withdrawal history signature and it indicates that you stopped CT in July and reinstated in November, please correct me if I am wrong.  

It is suggested that when a person tapered and the last dose was 1-3 months ago, go back to a very low dose, maybe 2mg-5mg (depending on the drug) to start with, increase after a week if it helped but isn't enough.  If the last dose was more than 3 months ago, warn that reinstatement might not work. Try a very small dose (in case of hypersensitivity), such as 2mg. If that helps but isn't enough, increase. If it doesn't help or makes symptoms worse, stop immediately.  Because Lexapro is one of the stronger antidepressants on the market, my suggestion was 1mg to start and to titrate up slowly if 1mg doesn't help.  Ultimately the decision is yours, but thought I should bring this to your attention so that you can make the best decision regarding your health and well-being.  Because you have only had one dose at 5mg, we often suggest adjusting the dose if we feel the initial reinstatement is too high a dose that might cause an adverse reaction, and again, the decision is yours to make.

Edited November 17, 2017 by baroquep

[derprant]

Do you suggest I wait to see if I get an adverse reaction, or just nip it in the bud and start taking a lower dose? I did a very small/obviously ineffective taper in July that probably amounts to a CT drop from like 20mg really. I only dropped to 10mg for a week or so...

[baroquep]

I would lean toward nipping it in the bud ... these drugs are very strong even in very small doses (far stronger than they need to be), and if you are already experiencing difficult withdrawal symptoms, it would be best to play it safe rather than upset your central nervous system even further.   

[derprant]

Fair call. I'll pick up a syringe plunger and make up some 1mg pastes and reduce to that. 

 

Thanks a lot for your input and help.

[baroquep]

Let us know how things are going over the next little while.  It is also a good idea to keep track of your daily symptom pattern so that you can see your progress and be alerted to any problems that can be missed on a day-by-day basis.  Wishing you well.  Keep us posted.

Rate Symptoms Daily to Check Patterns and Progress

[Altostrata]

4 hours ago, derprant said:

Do you suggest I wait to see if I get an adverse reaction, or just nip it in the bud and start taking a lower dose? I did a very small/obviously ineffective taper in July that probably amounts to a CT drop from like 20mg really. I only dropped to 10mg for a week or so...

 

4 hours ago, derprant said:

Fair call. I'll pick up a syringe plunger and make up some 1mg pastes and reduce to that. 

 

Thanks a lot for your input and help.

 

Yes, baroquep has got it, start low as an experiment, see what happens. Why take 5mg if 1mg will do the trick?

 

Please let us know how you're doing.

[derprant]

Quick update - Not great news, and some good news.

After my last post I began to spiral a bit (not due to any external pressures at all, hell I got a nice bonus at work last week!), ended up being taken to crisis care on Friday morning by one of my more understanding work colleagues who found me half catatonic in the storeroom and managed to escort me out without too many people even realising/noticing. Don't really remember what happened that much thank god, but the nurses initially tried to have me taken straight to the hospital before the doctor immediately reinstated me on 5mg lexapro and 5mg valium 3 times a day to counteract the insanity of the redosing anxiety. I can report that I was apparently given my first does of lexapro 5mg (along with a hefty dose of valium I think?) at around 10am, and LITERALLY by 10pm at night my WD symptoms had subsided so drastically that I was functional again. Today was a little rough with anxiety and depression, with a bit of extra anxiety from the redose, but since 10pm tonight I have (once again) improved a hell of a lot. The edge has been very much taken off the depression, and I'm not in constant sobbing fits, and the anxiety has been manageable (albeit with the valium helping). The good news is that I only took 7.5mg of valium yesterday and 10mg today, and am aiming to stop using it daily by Tuesday.

 

So where does that leave me? I'm definitely going to stick to 5mg now for the next few months. I saw the doctor from yesterday today and he was pretty shocked by my improvement too and has agreed to see me when I require, and will facilitate me tapering down when I'm ready. Hopefully seeing the difference between today and yesterday will make him more cautious in his care of patients on lexapro. He was also quite open to me wanting to taper EXTREMELY slowly, and is willing to give me a prescription for 20mg/mL lexapro formulation when I am ready to begin. I think that, after at least 4 months on 5mg, I will begin to taper at no more than 10% every 2 months. This should give me the buffer I need to observe my withdrawal, seeing as my original phase II symptoms appeared quite a bit later than seems to be usual. 

 

The thing that really scares me about all this is that these drugs are supposed to be 'non-addictive', and my experience clearly showed my family how false that is. And it is easy in hindsight to think 'oh, that crushing despair and hopelessness for life was obviously WD effects', but...damn, no matter how many times I read through my couple of weeks of journal, nothing would convince me of that or of ever recovering. Hell of a drug. I wish I did my research before I started so that I could treat them with the utmost care that they require.

 

Anyway, thanks again for all your care and input. It has been and sure will continue to be a source of guidance and support for me.

[TroubledThoughts]

Hey, just checking in to see how you're doing and if things have gotten better during your reinstatement?