ryan1982: my journey

[Altostrata]

Did anything change recently? Did you divide the Lexapro dose?

 

You can switch to the generic liquid by taking part of your dose in tablet form and part in liquid, gradually converting to all-liquid.

 

If symptoms arise after a drug change, they're because of the drug change, not because of a sudden emergence of a psychiatric disorder. However , if you tended to worry unnecessarily or had health anxiety before taking psychiatric drugs, it's very possible you'll still have this habit of mind. Is "GAD." a meaningless label, why you took psychiatric drugs in the first place?

 

Have you looked into food sensitivities contributing to interstitial cystitis?

[ryan1982]

Thanks, @Altostrata.  I haven't made any changes at all other than having magnesium a little over a week ago.  And what's crazy is that I'm not anxious, per se...I just feel edgy.  In my head, however, I am not worried about anything...just plugging away at my job.  

 

I haven't divided the dose because after I started keeping notes, it doesn't matter what time of day it is, I get side effects.  

 

As for IC, yes, I avoid lots and lots of food.  I have a bladder stimulator implant as well.  

 

Yes, I was put on medication when I was 23 (I'm 36) because I had anxiety, especially following a night of alcohol, which was very common back then.  I regret getting on these meds more than any decision in my life.  

[Altostrata]

Looking at your symptom notes, do you get the bulk of your symptoms before or after you take your daily Lexapro?

 

Smaller doses usually cause smaller side effects.

 

On 7/19/2018 at 4:27 PM, Altostrata said:

Would you say Lexapro makes you feel tired? If so, what you might want to do is divide the dose. Move 2mg of the 4mg an hour or two earlier in the day until you are taking it in the morning.

 

This may reduce the sleep disruption you get from taking 4mg all at once at night, the hangover effect the next morning, and the breakthrough symptoms in the afternoon. Since you're on such a low dose, it could be you are metabolizing it fast enough that you get a bit of withdrawal in the afternoon.

 

[ryan1982]

@Altostrata- I would assume after since I take my dose in the morning. 

[ryan1982]

This go-round I haven’t ever felt great on Lexapro so I’m wondering if Lexapro isn’t working for me or if there are any drugs at all that could work considering how destabilized I am. 

[Altostrata]

Hard to tell what might help, you've had so many drug changes in the last 2 years. Were all the drug changes at your request?

 

You've only been on 4mg Lexapro for 3 weeks, do you feel better or worse than at the beginning of July?

 

On 7/19/2018 at 4:06 PM, ryan1982 said:

I take my dose at 9 PM.

 

Did you change your dosing to the morning?

 

What is your daily symptom pattern? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

[ryan1982]

@AltostrataShoot- I got mixed up. I take my dose at night at 9 PM. 

 

Yes, I’ve tried lots and lots of things due to the fact that I had severe poop out after a surgery that went horribly wrong. My life hasn’t been the same. Lexapro was great up until that point...I actually got serotonin syndrome at that time and nothing has worked since. 

 

Its hard to say what if I feel better since I went to 4 MG. Nothing has been consistent as I swear magnesium and melatonin both threw me off since I started 4 MG. Previously on lower doses I would feel nauseous/dizzy/anxious at times but not *all* the time. Perhaps I’m just in a wave and need to give it more time?

[ryan1982]

As for daily symptom pattern, I do keep notes and there’s absolutley no rhyme or reason to it. This past weekend I felt nausea and dizziness, today I feel anxious/edgy. These symptoms generally last the entire day. 

[Altostrata]

We need to see your daily symptom pattern to answer your questions.

 

12 minutes ago, Altostrata said:

What is your daily symptom pattern? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Given your history over the last 2 years, you need to stop changing drugs for a while for us to see what's going on. If you have a habit of constantly second-guessing, you will need to stop that.

[ryan1982]

@Altostrata- fair point. 

 

I take my Lexapro dose at night before bed at 9:30 PM and generally fall right to sleep. I get up around 12 AM to use the restroom, again at 3:30ish and again at 6AM. I generally don’t sleep well at all after 3:30 AM...I can’t shut my brain off and the rest of the night is generally very restless. 

 

On days in which I work, I generally have meetings all day, every day. Lately I’ve had the edgy feeling start around 9 or 10 AM and last until I leave the office around 6 PM. I get home to my wonderful family and I’m so tired from the edginess that I have just enough energy to help with the kids and bedtime and then watch TV for an hour and fall into bed. Rinse, wash, repeat. 

 

On other days, I have nausea and dizziness that follows a similar pattern but it seems to hit me more on weekends when I don’t work. 

[Altostrata]

Thanks, ryan. Next time, the list format, please.

 

In the past, did you usually get up at night to urinate at those times?

[ryan1982]

@Altostrata- apologies, will do. 

 

I’ve had these bladder issues for as long as I can remember. Putting a small bladder on a 6 foot 5 inch male is just cruel...haha. 

[ryan1982]

55 minutes ago, Altostrata said:

Thanks, ryan. Next time, the list format, please.

 

In the past, did you usually get up at night to urinate at those times?

Given all this info, @Altostrata, what do you think? Keep it as is?

[Altostrata]

I am still guessing a divided dose might be helpful but I need to see that daily symptom pattern.

[ryan1982]

@Altostrata

It looks a little something like this:

6:30 AM- Wake up, generally have anxiety in the morning so I practice deep breathing. Take multivitamin, prebiotic, probiotic and fish oil capsule

8 AM- Get to work, sleepy (without coffee)

9- 12 PM- Meetings, the busier I am, the better.  My back starts to tighten up and I have occasional bouts of anxiety and tinnitus (constant but not terrible) 

12- 5 PM- Generally about the same as the 9- 12 PM but at this stage I am worn out from being so on edge

5- 9 PM- Exhausted but no longer on edge as I get home from work...body/back aches from work and stress

9 PM- take Lexapro 4 MG and get in bed

10 PM- Fall asleep with eye mask, white noise and ear plugs

12:30 AM- Wake to urinate

3:30 PM- Wake to urinate, usually have trouble falling back asleep here now that I am in withdrawals

6:30- Wake to urinate, up for the day

 

I will say that some days the anxiety is replaced with nausea and dizziness.  Other days are more manageable than others...some are even pretty good. This wave started Sunday, July 15 after I took magnesium (coincidentally or not) the night before.  I don't touch alcohol, cigarettes or any other drugs.  

 

What do you think?  Should I stay on the 4 MG dose?  I can't help but think that there isn't a drug in the world that could help me at the moment since my CNS is so sensitive at the moment with all of these changes.  

[Altostrata]

I still think it's very possible you are a fast metabolizer and the 4mg Lexapro at night isn't enough to give you coverage during the day, which is when you get breakthough withdrawal symptoms.

 

If I were you, I'd try dividing the dose by moving part earlier in the day by an hour or two at a time. If it makes you drowsy, I'd try moving 1mg earlier until you are taking it in the morning, and keep 3mg at 9 p.m. as usual. Be sure to keep notes every day about your symptoms, time of doses, and amount of doses.

 

Let us know how you're doing, particularly if there are any significant changes.

[ryan1982]

Cool. Thanks, @Altostrata.  You would do this rather than just move my dose to the morning?

[Altostrata]

ryan, escilatopram has a half-life of about a day. If you are a fast metabolizer, its half-life can be much shorter than that.

 

Since you're taking such a low dose, your metabolization might be rushing it out of your body over night.

 

Taking it in the morning may mean you get withdrawal symptoms at night instead of during the day, as may be the case now.

 

Why do you not want to divide the dose?

[ryan1982]

@Altostrata- thanks again for all your help.  Having people who understand and care means the world to me.

 

I'm completely open to it, just nervous as always to make any changes as I don't want to make things worse.  If I started it, I would take half my dose at 9 PM and the other half at 8 PM the first day, and on the second day I would take half at 9 PM and the other at 7 PM until I get to 12ish hours apart, correct?

 

Lastly, do you see issues with switching from branded to generic?

 

[Altostrata]

Yes, that is the way to move the dose.

 

Does escilatopram make you drowsy? If yes, you may wish to move only 1mg earlier in the day.

 

Do not switch to generic and move your doses at the same time. Are you using Lexapro liquid now? If yes, take part of your dose from the Lexapro suspension and part from the new generic suspension, accomplish the switch in stages.

 

 

[ryan1982]

@Altostrata- hey Altostrata- I hope you had a great weekend.  Quick update...I will take my first dose at 4 PM and my second at 9 PM today.  It's been really interesting and I've had some promising returns thus far.  Would you expect it to be a little tougher as you move the dose further apart?  I'm finding that today feels like I don't have enough drug in my system as we approach mid day.  

[Altostrata]

That actually confirms my theory, If I were you, I'd make a timing change only every 3 days, it takes a few days for your system to adjust to a dosing change.

[ryan1982]

@Altostrata- yes, it's a plan.  I'll move my dose very slowly, 3 days at each hour increment.

 

Also, I got the results of my Genesight back and they said that I have low folic acid production and have recommended Deplin.  I'm obviously nervous to try anything different...any thoughts on this drug?  

[Altostrata]

I wouldn't bother with Deplin. Low folic acid means you don't eat enough leafy greens and fresh fruits.

[ryan1982]

@Altostrata- hey Alto- I hope all is well!

 

Quick update- I’m still slowly moving my dose and im at 9 PM and 3 PM as of today. 

 

My sleep has been pretty terrible but it’s been that way for a long while now. Work has been pretty rough lately and while I have no trouble falling asleep, I can’t seem to stay asleep. 

 

My ears are are still ringing. Looks like this is a side effect of withdrawal...think I should go to and ENT or just ride it out?

[Altostrata]

When did the tinnitus start? Has moving the doses affected it?

 

You might want to take a little melatonin, such as 0.25mg, when you wake midnight-1 p.m am., it could help you fall back asleep.

 

Edited August 4, 2018 by ChessieCat
clarifed dosage amount and corrected time

[ryan1982]

@Altostrata- funny enough, it happened right after I took magnesium glycinate. I had a really bad reaction to it- nausea, dizziness and tinnitus. The nausea and dizziness happened before after magnesium so I can’t take it. Unfortunately the tinnitus has stayed for about 3 weeks and the nausea and dizziness has left. 

 

Thanks for the recommendation. Unfortunately I’ve also had a bad reaction to melatonin. My system is a mess. 

 

I potentially may have to have sugery soon on a collapsed septum and I’ve had this surgery before and it’s really painful. I know they will prescribe me Norco or oxycodone. What are your thoughts on taking those drugs? I’m not sure I’ll have much of a choice. 

[Altostrata]

If you must have the surgery and you don't have a choice about drugs, you'll have to accept what you need to do and not worry about it.

[ryan1982]

@Altostrata- sometimes we’re our own worst enemy. While on vacation with my family this week I ate a marijuana edible. It seems to have kicked up some symptoms- namely depression and nausea. It’s been like 36 hours or so. I’ve never really had much depression, just anxiety. Is this normal? When will it pass? Sorry to bother as I know this is my fault. I’ve learned my lesson. 

 

Would you recommend taking even a little bit of benzo to manage symptoms for a couple days?

[Altostrata]

Marijuana has a long half-life. If I were you, I would just let it wear off. Avoid taking a benzo.

[ryan1982]

@Altostrata- thanks, Alto. I’m still pretty darn depressed. Think it will go away soon?

[Altostrata]

What exactly do you mean by "depressed"? When did this start? Does it come in waves?

[ryan1982]

Maybe sad and hopeless is the best way to describe it? It’s honestly centered around some back pain I have- so much pain. 

 

I’m at 9 PM and 12 PM for my doses. Should I strive to get them 12 hours apart?

[ryan1982]

Sorry, forgot to tag you, @Altostrata

[Altostrata]

On 8/11/2018 at 10:28 AM, ryan1982 said:

Maybe sad and hopeless is the best way to describe it? It’s honestly centered around some back pain I have- so much pain. 

 

I’m at 9 PM and 12 PM for my doses. Should I strive to get them 12 hours apart?

 

Feeling down because you're in pain seems normal to me. (A friend is taking CBD oil for her back pain.)

 

How has your symptom pattern changed since you changed your drug schedule? We can't tell anything without your symptom pattern notes.

[ryan1982]

@Altostrata

 

Thanks so much.  I'm working on the back problems using Physical therapy.  I tend to overdo things and try to fix them, so I definitely reinjured myself.

 

The depression lifted late last week...I haven't felt back to normal yet though, the depression has been replaced by nausea and a floaty feeling.  There isn't a real rhyme or reason to it.  I think this is related more to the marijuana and lack of sleep than anything else.  I've had around 4 beers in the last week but I've reacted well to that in the past.  I did try and take 2 normal strength ibuprofen on Sunday and I feel like I took a benzo I was so out of it.  

 

Here's my symptom pattern over the last few days:

7 AM- Wake up and eat, no real issues other than nausea.  Food seems to help.

7- 11 AM- Go to work, feel tired from lack of sleep

11 AM- Take pill

12- 5 PM- Usually pretty tired and floaty, try and keep my mind busy at work

5- 8 PM- Physically exhausted and in pain and usually focus as much on my kids as possible

9 PM- Get ready for bed, take 2nd half of pill

9:30 PM- Sleep

12 AM- Wake up to use restroom

3 AM- Wake up to use restroom

4- 6 AM- Usually toss and turn

7 AM- Wake up